The nurse calls Ronnie in for his appointment
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Non concordance can be divided into 2 separate underlying causes.
1. Intentional non-concordance.
This is where patient’s beliefs mean they make a conscious decision to not take their medications. It is important that health care professionals allow patients to express their beliefs in a non-judgemental environment. Some possible reasons for intentional non concordance are:
- Belief that medicines are no longer required.
- People can believe that long term making mediation can be harmful to their health as it develops dependency or build-up of the drug in heir system.
2. Non-intentional-non-concordance
This can be when:
- People forget
- They are too busy
- Or they stop for a period of time due to other factors, for example, family stress.
In order to suitably address non-concordance it is essential to fully explore and understand the reasons for it. Such discussions can often lead to the development of trust and respect between the patient and the health care professional.
Nurse: Hi Ronnie, it’s nice to see you. How are you?
Ronnie: Ach, not bad… Just getting on with it, y’know?
Nurse: Let me check your blood pressure and pulse and then we can have a talk about things.
The Nurse checks Ronnie’s BP in both arms. His Blood Pressure is 165/103.
Nurse: Your blood pressure is higher than we’d like today. We”ll just have a chat for a few minutes and then I’ll check it again.
Ronnie: No wonder it’s high! I hate hospitals, Health Centres and the like. No offence! I was just so worked up this morning. What with all the hassle of getting here that I forgot to take them! Will that have affected it?
Nurse: How often in the last week have you forgotten to take them?
Ronnie: It’s not even so much that I forget, it’s hard to motivate myself to take them. I spend so much time at work, and when I get home I just want to watch TV or go to the pub. I feel the things I enjoyed have been taken from me…
Nurse: What hobbies have you had in the past that you enjoyed?
Ronnie: When I was married, I loved doing the garden. I was proud of my garden. People often commented on how nice it was and I really enjoyed learning a lot about plants.
Nurse: Is that something you would like to go back to doing?
Ronnie: I can’t, I live on the 15th floor!!!
Nurse: We could have a look together just now to see if there are any garden projects near you that you would be interested in becoming involved in?
Pulse point
50-80% of people with hypertension do not take all their medications.
Non-concordance with medicines for long tern conditions is common and is more likely the more medicines that are prescribed (Lloyd et al 2014).
Assess concordance regularly.
Consider the following:
1. Ask the question in a way that does not apportion blame. Instead of saying “Do you take your tablets?” say, “It can be difficult to remember to take your tablets. In the past week, how often would you miss taking your tablets?”
2. Mentioning a specific time frame helps, such as, “In the last week”
3. Asking about medicine taking behaviours, such as reducing doses and stopping and starting medicines.
Strategies to aid concordance:
Despite the lack of direct evidence, you may want to consider:
1. Simplifying dosing regimes
2. Encouraging the person to record medicines taking
3. Social prescribing to minimise barriers to concordance
Page last reviewed: 17 Sep 2020
