Page 194 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Introduction 169

Introduction

Optimum outcomes in wound care are only possible with
effective treatments that are implemented meticulously.
According to the World Health Organisation, patient con-
cordance is the ‘single most important modifiable factor that
compromises treatment outcome’ (WHO 2003 ). Good con-
cordance can therefore have an important influence in pre-
venting relapse and optimising health care (Wahl et al. 2005 ).
In contrast, non-concordance with prescribed treatments has
implications for the health of the patient, the effective use
of resources, and the assessment of the clinical effectiveness
of treatments (Playle and Keeley 1998 ). Indeed, the implica-
tions for the patient of non-concordance to prescribed treat-
ment range from an increase of symptoms and deterioration
of health, through compromised quality of life, to a potential
risk to life (WHO 2003 ); the potentially serious impact which
poor concordance can have for a patient with a wound has
been noted (Hallett et al. 2000 ).
Up to 80 % of patients can be expected not to comply
with their treatment at some time (Dunbar-Jacob et al. 1995 ),
and patients with chronic health problems tend to have the
highest non-concordance rates for treatment and lifestyle
changes. This is because risk of poor concordance increases
with the duration and complexity of treatment regimes, and
both long duration and complex treatment are characteristic
of chronic health problems such as wounds. Non-concordance
rates are thought to average 50 % for long-term health condi-
tions (WHO 2003 ), with similar figures being reported for a
range of chronic wound types (e.g. Ertl 1992 ; Erickson et al.
;
1995 Stewart et al. 2000 ).
It has been suggested that concordance can be either
intentional or unintentional. However, explanations for non-
concordance differ depending on the respondent’s viewpoint.
In a comprehensive review of the literature concerning con-
cordance in patients with leg ulcers, Van Hecke et al. ( 2008 )
found that nurses focused primarily on patient-related fac-
tors such as poor motivation, lack of understanding and