Introduction
Concordance between patients and doctors implies that the health beliefs of both are respected and incorporated in patient health care (1). However, much work is needed to resolve any conflicting views before concordant partnerships can be developed (2). With pharmacists and nurses becoming more involved in the clinical management plans of patients as part of supplementary prescribing (3), patients will have more of a need to discuss therapy changes with health professionals other than doctors. The perspectives of patients and health professionals on the problems experienced by patients would enable us to assess what each considers important. Definitions and approaches to identifying drug-related problems have largely been from the perspectives of health professionals rather than patients. Recent research has shown that the patients' perspectives are vital in ensuring the safe and appropriate use of medicines by patients (4).

Objectives
1. To compare the problems rated by health professionals using a clinical significance scale, with the patients' perspectives of their problems.
2. To describe the problems which were intervened on from the perspectives of patients and to compare these with the ratings of health professionals.

Method
In-depth home interviews were conducted with sixty-four patients to confirm drug-related problems originally identified using a screening tool in medication reviews held in GP surgeries and community pharmacies. Qualitative descriptions of the problems were also obtained from patients. Case vignettes summarising the problems identified were prepared. The case vignettes were given to GP and pharmacist pairs, who were invited to rate the clinical significance of the problems using a major, moderate and minor scale. Wilcoxon signed rank test was used to compare the ratings of GPs and pharmacists of the problems. The qualitative descriptions of the problems were analysed inductively.

Results
No statistically significant differences were identified overall between the ratings of the problems by the GPs and pharmacists. Many of the problems rated as minor by health professionals were perceived by participants to be important enough to warrant an intervention. In relation to the patients' qualitative descriptions on their problems, participants perceived all problems as important whereas health professionals rated them according to their nature.

Conclusion
To date, no definition of drug-related problems has identified drug-related problems from the patients' perspectives. Patients' perspectives are a very central and important element of effective concordant partnerships between patients and health professionals, irrespective of health professionals' opinions.

References
1. RPSGB/ Merck, Sharp and Dohme. From compliance to concordance. Achieving shared goals in medicine taking. 1997. Pharmaceutical Press, London.
2. Barry CA, Bradley CP, Britten N, Stevenson FA, Barber N. Patients' unvoiced agendas in general practice consultations: qualitative study. British Medical Journal 2000; 320:1246-50.
3. Department of Health. Supplementary prescribing by nurses and pharmacists within the NHS in England. A guide for implementation. 2003. HMSO, London.
4. Gordon KJ, Dhillon S and Smith FJ. Drug related problems in cardiovascular patients: a primary care approach. Pharmaceutical Journal 1999; 263:R6-7.