The concept of concordance in medicine-taking emphasises the active role of the patient in decision-making about treatments. This is a consequence of the doctor-patient relationship being regarded as a partnership between equals¹. Previous work has shown that the 12-item Leeds Attitude to Concordance (LATCon) scale is a reliable and valid tool for assessing healthcare providers' attitudes². The purpose of this study was to pilot this scale on patients' attitudes towards concordance.

Method

The 12-item LATCon scale, developed to measure attitudes of health professionals was used. Each item is a statement reflecting the concordance philosophy and each response a Likert scale of strongly disagree (0), disagree(1), agree(2), strongly agree(3). The only change was substituting 'doctor' for 'prescriber' in the statements.

It was distributed to 157 consecutive adult attenders at Mytholmroyd Health Centre, Yorkshire, who completed the scale in the waiting room. Demographic details were collected on patients' age, gender, whether on any long-term medication and self-reported number of GP visits over the past year. Twenty respondents were invited to take part in a short semi-structured interview that will be reported elsewhere.

Results

In total, 150 patients completed the scale. Patients had a range of attitudes to concordance, across the spectrum. Item analysis of the scale demonstrated that it had a good internal reliability (Alpha = 0.77). Mean scale scores were calculated for the whole sample and for sub-groups formed by demographic variables.

Independent samples t-tests demonstrated a significant difference in attitudes toward concordance between males and females (p=.026), with females favouring the concept more than males, but no significant difference relating to the taking of long-term medication (p=.37). Analysis of variance demonstrated a significant effect of age on attitudes toward concordance, with younger patients being more favourable (p=.042). Post-hoc comparisons demonstrated a significant difference in attitudes between patients aged under 40 years and those above 60. No significant effect of the self-reported number of visits to the GP over the past year was found (p=.74). Multiple regression analysis demonstrated that the age of the patient contributed most to the variance in scale scores and was therefore the best predictor of attitudes toward concordance. No other variable contributed significantly to the variance.

Discussion

Further study is required to assess the reliability of the scale over time. Once fully validated, the scale may be used in research into individual patient differences in expectations of care. It could also be used in clinical settings, to allow GPs to under-stand the preferences of individual patients. They could then approach a consultation on an individual level, with prior knowledge of what each patient expects and desires.

References

1. Royal Pharmaceutical Society of GB. From compliance to concordance. Achieving shared goals in medicine taking. London: RPSGB, 1997
2. Raynor DK, Thistlethwaite JE, Hart K, Knapp P. Are health professionals ready for the new philosophy of concordance in medicine taking? Int J Pharm Pract 2001:9:81-84