Concordance and non-compliance: a psychological perspective

A total of 50% of prescribed medications are not taken properly (Stoate et al, 2000; World Health Organization (WHO), 2003; Brown and Bussell, 2011). Some estimate this figure could be as high as 75%, as most patients will discontinue their medication without informing their prescriber (Walker and MacAulay, 2005). Therefore, it is recommended that good prescribing practice should address the issue of concordance (National Institute for Health and Care Excellence (NICE), 2009). When reviewing the literature on concordance, the term non-compliance is frequently found (Schulz, 2020); the dictionary definition for this is given as ‘a failure to act in accordance with a wish or command or with a formal requirement’ (Concise Oxford Dictionary, 2015). What this definition lacks is any acknowledgement of the person behind the patient or the health professional trying to manage a complex prescribing consultation. Interestingly, whilst there is little consensus within the literature as to the causes of non-compliance, there is, however, significant consensus as to what might mitigate it, and these coalesce around making consultations more patient centred. This paper will consider what the evidence tells prescribers about patient-centred approaches within prescribing and why they need to form the basis of the prescriber's practice if the challenge of concordance is hoped to be met.