Contracts between patients and healthcare practitioners for improving patients' adherence to treatment, prevention and health promotion activities

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.
Review CD#: 
CD004808
PEARLS No: 
22
Date: 
October, 2007
Authored by: 
Brian R McAvoy