Publications (1)0 Total impact
ABSTRACT: The concept of concordance is based on negotiation between equal partners in a therapeutic relationship to effect a therapeutic alliance. Its strength lies in respect for the patients agenda and the creation of openness in the relationship. One field of therapeutics in which concordant relationships may be particularly valuable is the integration of complementary and alternative medicine (CAM) into the conventional medicine paradigm. CAM is increasingly a reality in health care. Further, principles of holism and patient-centeredness in CAM parallel the principles of concordance, and exploring the two paradigms in concert was considered conceptually valuable. Review of the international literature identified a lack of research regarding concordance and partnerships in CAM, and concordance in general. The aim of this research was therefore to explore and improve the understanding of consumers perspectives and experiences with conventional medicines and practitioners (general practitioners (GPs) and pharmacists) and CAM practitioners, in order to propose how relationships and therapeutic partnerships between all four parties may be enhanced. The initial research stage involved qualitative and quantitative data collection from a sample of 83 consumers with a chronic condition (cystic fibrosis) to determine their CAM use and issues relating to their relationships with their conventional and CAM practitioners. In this sample, 26% were consulting a CAM practitioner and 45% were using CAM; this was comparable with general population data. Findings of concern were failure to disclose potentially harmful CAM use to conventional practitioners, despite their positive relationships. This study emphasised the importance of communication between consumers and health care practitioners in therapeutic management. A second study explored beliefs and expectations of GPs, consumers and pharmacists to allow further insight into the principles of concordance in health care. This involved qualitative data collection through focus groups with seven consumers and nine pharmacists and in-depth semi-structured interviews with ten GPs in Brisbane. Discussion and interview topics were derived from the current concordance literature. The data were transcribed, independently checked, thematically analysed and used to develop a model to test the application of concordance in pharmacy and medical practice. Despite developing a method for the concordance initiative, attempts to recruit GPs and pharmacists for the trial were unsuccessful. Useful feedback was gathered from contacted GPs and pharmacists. To further explore perceptions on relationships, concordance and CAM use between GPs, pharmacists, CAM consumers and CAM practitioners, a subsequent problem detection study (PDS) was designed. PDS methods are increasingly accepted in health care, usually involving qualitative and quantitative survey research to explore similarities and differences in perceptions between groups of participants. The PDS method initially involved a further focus group with eleven CAM consumers to identify issues specific to CAM and relationships for this group. These qualitative data, in combination with the preceding focus groups and interviews, revealed seven common themes. The themes formed the basis of questionnaire research in GPs, pharmacists, CAM practitioners and CAM consumers. The questionnaire was self-completed and anonymous, and consisted of general demographic descriptors and 36 statements (derived from the seven themes) measured using a five-point Likert scale. Sixty CAM practitioners, 57 GPs, 83 CAM consumers, and 172 pharmacists responded. Analysis was performed by comparison of responses to the 36 statements between the four respondent groups. The findings were interpreted with respect to the original seven themes. In a confirmatory process, principal components analysis, a data reduction technique, was applied to the 36 variables to statistically assess underlying factors. This process identified six factors explaining 56% of the variance. Systematic comparison of the factors with the constituent variables and original themes identified some consistency between the factors and the initial seven themes, but also highlighted new and more congruent themes within the data. The various analyses within this PDS raised a number of issues with respect to challenges in achieving concordant relationships between the four groups, such as the importance of mutual respect and communication, and understanding of roles and limitations. A key recommendation from this research stage is to trial a practice-based concordance intervention/exercise involving both conventional and CAM sectors in Australia. In conclusion, this research has examined the views and experiences of consumers, pharmacists, GPs, and CAM practitioners regarding their inter-personal relationships and partnerships. The findings from the various research stages showed that CAM use was established in the sample populations, and that consultations with CAM practitioners are a valid consideration in the enhancement of concordant therapeutic relationships. Barriers to achieving concordance included lack of time and remuneration for quality interaction and information sharing between health providers and consumers, and current lack of system support for the implementation of the principles of concordance. However, the concept of partnerships (concordance) was favoured by all four groups in general, despite some considerable differences in opinion within and between groups. There is a place for advancement of the principles of concordance in both conventional and CAM fields of health care in future health care practice and research in Australia.