Promoting concordance Bell et al (2007) view concordance as a patient-centred concept, a shared decision-making process by which the patient and clinician make decisions regarding treatment together. The aim is to create a therapeutic alliance with parents and young people in order to optimize the impact of treatment. Horwitz et al (2012), following a longitudinal study with parents of children receiving outpatient mental health services, concluded that young people and their families are both keen to be involved in decision-making. Concordance, and most other decision-making models, respect the patient’s right to autonomy. Clyne et al (2007) developed a framework for
concordance: ‘a process of prescribing and medicine-taking based on partnership’. This framework (Figure 1) proposes ‘pillars of concordance’: ■ Sharing knowledge ■ Achieving a successful consultation ■ Supporting patients in taking their medication. Patients need to have sufficient knowledge of their treatment to be able to participate as partners in decision-making. It has been proposed by Cheesman (2006) that nurse prescribers’ enhanced consultation skills allow them to engage patients in valuable discussions about medication. The foundation of a concordant style of consultation is the patient being respected as a partner and being supported to be involved in decisions about treatment (Clyne et al, 2007). The third pillar identifies the importance of regular reviews, which provide opportunities for discussion about medication and medicine-taking