Monday 01 October 2007, 12:00AM
PEARLS 22, October 2007, written by Brian R
McAvoy
Clinical question
Can contracts between patients and healthcare
practitioners improve patients' adherence to treatment, prevention
and health promotion activities?
Bottom line
There is limited evidence that contracts can potentially
contribute to improving adherence. However, large, good quality
studies do not provide evidence to routinely recommend contracts
for improving adherence to treatment or preventive health
regimens.
Caveat
Trials evaluated the use of contracts in the treatment of
addiction, hypertension, weight control and a variety of other
areas. Effects on adherence were not detected when measured over
longer periods, eg, 6 or 12 months.
Context
Contracts are a verbal or written agreement that a patient makes
with themselves, with healthcare practitioners or with carers,
where participants commit to a set of behaviours related to the
care of a patient. Contracts aim to improve the patient's adherence
to treatment or health promotion programmes.
Cochrane Systematic Review
Bosch-Capblanch X, Abba K, Prictor M, Garner P. Contracts
between patients and healthcare practitioners for improving
patients' adherence to treatment, prevention and health promotion
activities. Cochrane Database of Systematic Reviews 2007, Issue 2.
Article No. CD004808. DOI: 10.1002/14651858.CD004808.pub3. Note:
This review contains 30 trials involving 4691 participants