From compliance to concordance: barriers to accomplishing a re-framed model of health care interactions

• Published in: Social science & medicine (1982) Vol. 58; no. 4; pp. 851 - 862
• Main Authors: Bissell, Paul, May, Carl R, Noyce, Peter R
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-02-2004; Elsevier; Pergamon Press Inc
• Series: Social Science & Medicine
• Subjects: Asian Continental Ancestry Group - psychology; Biological and medical sciences; Compliance; Concordance; Concordance Compliance Diabetes Doctor-patient interaction Ethnic minorities UK; Diabetes; Diabetes Mellitus, Type 2 - ethnology; Diabetes Mellitus, Type 2 - psychology; Diabetes Mellitus, Type 2 - therapy; Diabetics; Disease Management; Doctor-Patient interactions; Doctor–patient interaction; Ethnic minorities; Health care; Health Knowledge, Attitudes, Practice; Humans; Interviews as Topic; Medical sciences; Minority & ethnic groups; Miscellaneous; Pakistan - ethnology; Pakistani people; Patient Compliance - ethnology; Patient Compliance - psychology; Patient Participation; Physician patient relationships; Physician-Patient Relations; Practitioner Patient Relationship; Public health. Hygiene; Public health. Hygiene-occupational medicine; South Asian Cultural Groups; Treatment Compliance; United Kingdom; United Kingdom; Europe; Doctor–patient interaction; Ethnic minorities; Diabetes; Compliance; Concordance; UK; Concept; Human; Interaction; Definition; Barrier; Health staff patient relation; Doctor-patient interaction; Care; Philosophical aspect; Treatment compliance; Models; Public health
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/S0277-9536(03)00259-4

As a framework for organising health care interactions, compliance and adherence have come in for increasing criticism in recent years. It has been suggested that interactions with patients should not be viewed simply as opportunities to reinforce instructions around treatment: rather, they should be seen as a space where the expertise of patients and health professionals can be pooled to arrive at mutually agreed goals. This concept—known as concordance—is attracting increasing interest in health services research within the UK. In this paper, we seek to empirically explore the relevance of a re-framed consultation through qualitative interviews with a small group of English speaking patients of Pakistani origin with a diagnosis of type 2 diabetes.
We suggest that the focus of many respondents in this study on material and structural factors limiting diabetic regimen integration and the emphasis on a ‘doctor-centred’ model of health care interactions represent distinct problems for the accomplishment of the concordance project. However, given that some patients sought greater understanding and appreciation by health professionals of the subjective aspects of living with diabetes, if it is evaluated at the level of health care relationships, rather than health outcomes (such as improved compliance) concordance may well be a significant development for those who suggest that respect for the patients agenda is a fundamental aspect of health care.