Towards concordance in healthcare: perspectives of general practitioners, complementary and alternative medicine practitioners and pharmacists in Australia

Abstract

Partnerships and concordance are desirable concepts for optimal healthcare. The concept of concordance is based on negotiation between equals in a therapeutic relationship, forming a therapeutic alliance between all partners. One field of healthcare in which concordant relationships may be particularly desirable is complementary and alternative medicine (CAM). CAM is increasingly used by consumers worldwide, and provider-patient relationships are important across the spectrum of CAM-to-conventional medicine; thus, it was considered useful to research CAM and concordance in parallel. The objective of this problem-detection study (PDS) was to investigate practitioners' (general practitioners', pharmacists' and CAM practitioners') views on their relationships and reaching concordant partnerships with consumers in the areas of both conventional medicine and CAM. Focus groups and semi-structured interviews guided the development of the PDS instrument. The questionnaire consisted of 36 items corresponding to seven thematic units deduced from the preliminary data. The differences in perceptions between the surveyed groups indicated that achieving concordance relies on mutual respect and communication and understanding of roles, responsibilities and limitations, and differences in opinion may be compromising the formation of partnerships. Potentially problematic issues identified by this research could be addressed by educational interventions and enhancement of communication between all parties involved, as information loses value when not shared, and may be prone to contradiction and confusion. Further research is warranted in order to facilitate positive changes in the health system.

Consumers' experiences and values in conventional and alternative medicine paradigms: a problem detection study (PDS)

“…This is consistent with another trend - the increasing focus on 'concordance' in relationships between healthcare practitioners and consumers in the conventional healthcare model [10]. Concordance is based on negotiation between partners in a therapeutic relationship (consumer and healthcare practitioners), its strength being respect for the consumer's agenda and the creation of openness in the relationship [11-14].…”

“…The concept of problem identification arising from differing perceptions of the same issue/statement is very useful for future intervention design and evaluation. The principle behind this PDS was to investigate similarities and differences between consumers' ratings of issues relating to CAM and concordance compared to those rated by healthcare practitioners in a previous study, reported elsewhere [10]. …”

“…The transcript was thematically analysed manually into the key issues by a researcher (JF) and checked independently by the co-researchers (LE, ST) to minimise subjectivity of interpretation. Thirty-two key issues were identified by manual thematic analysis from this process in combination with interviews (10 general practitioners) and focus groups (9 pharmacists) with health professionals (as detailed elsewhere [10]).The identified issues from the consumer focus group (in conjunction with those from the health professional groups, reported elsewhere [10]) were then thematically analysed and summarised manually through a systematic process of data reduction into seven themes by a researcher (JF) [30,31]. No particular number of themes was sought in this analysis.…”

“…The accuracy of this data reduction was also checked independently by researchers LE and ST to minimise personal interpretation bias [30,31]. These themes were used to develop the questionnaire (below), as described previously [10]. A single CAM consumer focus group was used as data were also collected from the other groups to extract the themes and develop the statements.…”

Toxicology and safety of the tincture of Operculina alata in patients with functional constipation

“…However, it has been observed in the last decades a constant increase of the use of herbal medicines, which has been encouraging scientific studies for the discovery of new substances with therapeutic action and for the confirmation of the efficacy and safety of medicines derived from plants (Hansen et al, 2010;Ma et al, 2010;Moraes et al, 2012). The safe use of herbal drugs requires knowledge of their chemical properties and possible adverse effects (Fejzic et al, 2010;Teschke et al, 2010). Plant materials are used throughout the world as home remedies or raw materials for the pharmaceutical industry and represent a substantial proportion of the global drug market (Bosnic et al, 2007).…”