Patient-centred prescribing, autonomy and concordance
Joe Nordoff, Advanced Clinical Practitioner (ACP) in Primary Care, Chapel Group Medical Centre, Salford. Email: email@example.com
This article in the JPP Prescribing Paramedic series will focus on patient-centred prescribing, autonomy and concordance. Patient-centred prescribing means putting the patient at the centre of everything we do as clinicians. Autonomy means a patient has an inherent right to make decisions about their care. Concordance means the patient takes medication as prescribed, for the correct length of time. This article details how these three aspects of prescribing can be achieved by the paramedic prescriber, detailing strategies to ensure a consultation and prescribing decision is patient-centred while respecting autonomy, and how concordance can be improved. The article uses a patient consultation as a framing device to detail how these essential aspects of prescribing can be achieved.
Key words l Advanced practice l Prescribing l Paramedic l Concordance l Patient-centred prescribing l Autonomy
Accepted for publication:11 June 2021
Patient-centred prescribing is putting the patient at the centre of everything we do. Simon et al (2020) advise that the fact a medication can be prescribed for a particular condition does not mean it necessarily should be prescribed. This means the paramedic prescriber must ask themselves (among other things) ‘what are the risks versus benefits’? Autonomy is one of the four ethical principles from Beauchamp and Childress’ seminal work on medical ethics (1979) (the others being beneficence, non-maleficence and justice), and it means recognising and respecting a patient’s ability to come to their own decisions about their care. Concordance is the accuracy with which the patient follows the prescribed treatment regimen; a high level of concordance means that the patient takes the prescribed medication correctly, at the correct times of day and for the correct length of time ( Joint Formulary Committee ( JFC) 2020). A high level of concordance is however rarely the case, which will be later discussed. These topics are important to all prescribers, but to paramedic prescribers in particular as the newest prescribers on the block. The Royal Pharmaceutical Society (RPS) (2016) prescribing framework advises that prescribing is not a right, but a responsibility. This means it is our duty as paramedics to prove we are equal to that responsibility. The Health and Care Professions Council (HCPC) (2019) have adopted the RPS (2016) framework for their own paramedic prescribing framework and expect all paramedic prescribers to adhere to it. Paramedic prescribers are fully capable of driving the paramedic profession forward and upward but—in the words of Spiderman’s uncle—‘with great power comes great responsibility’.
The patient at the centre The following patient example provides a framework for discussion. The patient’s name has been changed to ensure confidentiality, and only the information relevant to this article is presented. The examples is therefore not meant to demonstrate a complete patient assessment. Mr Smith was a 48-year-old male with a 3-week history of increasing upper abdominal pains and heartburn. There were no red flags present, and the patient was not systemically unwell. He had suffered from the same symptoms intermittently since his late 20s, and an abdominal examination produced normal results. He had tried over-the-counter anti-acid treatment but with only minimal relief. He was previously successfully treated with omeprazole—a commonly used proton pump inhibitor effective for acid reflux ( JFC, 2020)—from which this patient was diagnosed as suffering. A further course of omeprazole 20 mg daily was prescribed and the patient’s symptoms settled after approximately 5 weeks of use. This demonstrates a relatively simple yet very common problem in primary care.
What does the literature say? Knight (2013) stresses that patient-centred prescribing naturally follows a patient-centred lthcare Ltd
Vol 13 No 7 • Journal of Paramedic Practice