Page 197 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

172 Chapter 7. Concordance

Adherence is defined as ‘the extent to which the patient’s
behaviour matches agreed recommendations from the pre-
scriber’ (Horne et al. 2005 ). The use of the phrase ‘agreed
recommendations’ moves away from the idea of the patient
as a passive recipient of health care who needs to obey the
directions given by all-knowing professionals; adherence
implies greater patient commitment to treatment, introduces
an element of reasonable negotiation, and reflects increased
patient empowerment.
The term adherence has, however, been criticised for not
moving far enough away from traditional paternalistic mod-
els of care. Snelgrove ( 2006 ) suggests that whilst the refer-
ence to adherence acknowledges the negotiation between
patient and clinician, it still suggests a certain degree of
patient passivity, and implies that the power in the relation-
ship remains predominantly with the clinician. In a response
to this, some clinicians and researchers have used the term
concordance in place of either compliance or adherence. The
advantage of this term is that it suggests that the patient is an
equal partner, one who shares in the decision-making process
(Weiss and Britten 2003 ). Metcalfe ( 2005 ) succinctly sum-
marises the similarity between compliance and adherence
and their difference to concordance noting that whilst com-
pliance and adherence can refer to behaviour by one person,
concordance cannot – by definition concordance requires an
active discussion, and therefore involves more than one indi-
vidual. The idea of patient concordance is very much in line
with the current ethos in modern heath care which puts a
high value patient autonomy, self-regulation and self-
management, particularly in relation to long-term conditions
and chronic illness. The emphasis is on shared decision mak-
ing, which takes into account a patient’s circumstances, wants
and desires. Concordance also demands that the clinician
focuses on the consultation process, ensuring they adapt it to
suit the needs of the individual patient (Metcalfe 2005 ).
There has however, been some criticism of concordance as
a concept and the terms adherence and compliance continue
to be used in preference by some clinicians and researchers.
Segal ( 2007 ) for example, has suggested that the use of the