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

Paul Bissell, Carl R May, Peter R Noyce

Research output: Contribution to journalArticle

192 Citations (Scopus)

Abstract

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.
LanguageEnglish
Pages851-862
Number of pages12
JournalSocial Science and Medicine
Volume58
Issue number4
Early online date16 Jun 2003
DOIs
Publication statusPublished - Feb 2004
Externally publishedYes

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health care
Delivery of Health Care
interaction
health professionals
chronic illness
Compliance
qualitative interview
Diagnostic Self Evaluation
small group
Health Services Research
Health
speaking
respect
health service
expertise
criticism
Type 2 Diabetes Mellitus
Health Status
instruction
Referral and Consultation

Cite this

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From compliance to concordance : barriers to accomplishing a re-framed model of health care interactions. / Bissell, Paul; May, Carl R; Noyce, Peter R.

In: Social Science and Medicine, Vol. 58, No. 4, 02.2004, p. 851-862.

Research output: Contribution to journalArticle

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