Concordance-based adherence support service delivery: consumer perspectives.
OBJECTIVE
To explore consumers' attitudes towards, and expectations of, adherence support services in primary health care, specifically in community pharmacy; and to explore consumers' attitudes towards the concept of concordance.


METHODS
An exploratory qualitative study conducted in Metropolitan Sydney, Australia.


METHODS
Three focus group discussions with consumers on chronic therapy (n = 22) and two focus groups with consumer representatives (n = 15) were conducted in 2002. Consumer representatives were peer educators volunteering in an association which promotes quality use of medicines among elderly patients. All discussions were audio-taped, transcribed verbatim and thematically content analysed.


METHODS
Consumers' experiences with adherence support services delivered by general practitioners and pharmacists, their expectations towards general practitioners' and pharmacists' role in adherence support; and attitudes towards concordance in consultations.


RESULTS
Participants expected an increased provision of medicine information and a reduction in the number of medications taken as the main strategies to promote adherence. They believed that once understandable information had been delivered, it was their responsibility to take their medications as prescribed. Yet participants frequently complained about the information received, especially from doctors. Only a subgroup of participants expected pharmacists to be involved in adherence support services. These participants generally relied on pharmacists for medicine information and were satisfied with the communication process when interacting with the pharmacists. All participants were positive about concordance, because they valued two-way communication and increased consideration of their needs and beliefs by healthcare professionals. However, they were hesitant about being involved in a shared treatment decision-making process. Many participants focused on concordance with doctors and identified barriers to the establishment of concordance: time pressures, financial constraints, the gap of competence and power between patients and doctors.


CONCLUSIONS
Pharmacists should consider consumers' needs for information and establishing concordance, as well as their expectations of the pharmacy profession, in delivering concordance based adherence support services. Given participants' high demand for medicine information, an opportunity might exist for pharmacists to influence consumers' expectations by offering information which is tailored towards their needs.
Du Pasquier
Sophie
S
Faculty of Pharmacy, Building A15, The University of Sydney, Sydney, NSW 2006, Australia. Sophie.du-pasquier@hospvd.ch
Aslani
Parisa
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003157:Community Pharmacy Services / Q000458:organization & administration / Q000592:standards; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009517:New South Wales; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards*; D010358:Patient Participation / Q000523:psychology; D017060:Patient Satisfaction; D010595:Pharmacists / Q000458:organization & administration / Q000592:standards; D010821:Physicians, Family / Q000458:organization & administration / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration; D024382:Professional Role; D055815:Young Adult