Intervention Review

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

  1. Xavier Bosch-Capblanch1,*,
  2. Katharine Abba2,
  3. Megan Prictor3,
  4. Paul Garner2

Editorial Group: Cochrane Consumers and Communication Group

Published Online: 18 APR 2007

Assessed as up-to-date: 28 MAY 2004

DOI: 10.1002/14651858.CD004808.pub3


How to Cite

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. Art. No.: CD004808. DOI: 10.1002/14651858.CD004808.pub3.

Author Information

  1. 1

    Swiss Tropical Institute, Swiss Centre for International Health, Basel, Switzerland

  2. 2

    Liverpool School of Tropical Medicine, International Health Group, Liverpool, Merseyside, UK

  3. 3

    Australian Institute for Primary Care, La Trobe University, Cochrane Consumers and Communication Review Group, Bundoora, VIC, Australia

*Xavier Bosch-Capblanch, Swiss Centre for International Health, Swiss Tropical Institute, Socinstrasse 57, Basel, CH4002, Switzerland. X.Bosch@unibas.ch.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 APR 2007

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Background

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 patients' adherence to treatment or health promotion programmes.

Objectives

To assess the effects of contracts between patients and healthcare practitioners on patients' adherence to treatment, prevention and health promotion activities, the stated health or behaviour aims in the contract, patient satisfaction or other relevant outcomes, including health practitioner behaviour and views, health status, reported harms, costs, or denial of treatment as a result of the contract.

Search methods

We searched: the Cochrane Consumers and Communication Review Group's Specialised Register (in May 2004); the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library 2004, issue 1); MEDLINE 1966 to May 2004); EMBASE (1980 to May 2004); PsycINFO (1966 to May 2004); CINAHL (1982 to May 2004); Dissertation Abstracts. A: Humanities and Social Sciences (1966 to May 2004); Sociological Abstracts (1963 to May 2004); UK National Research Register (2000 to May 2004); and C2-SPECTR, Campbell Collaboration (1950 to May 2004).

Selection criteria

We included randomised controlled trials comparing the effects of contracts between healthcare practitioners and patients or their carers on patient adherence, applied to diagnostic procedures, therapeutic regimens or any health promotion or illness prevention initiative for patients. Contracts had to specify at least one activity to be observed and a commitment of adherence to it. We included trials comparing contracts with routine care or any other intervention.

Data collection and analysis

Selection and quality assessment of trials were conducted independently by two review authors; single data extraction was checked by a statistician. We present the data as a narrative summary, given the wide range of interventions, participants, settings and outcomes, grouped by the health problem being addressed.

Main results

We included thirty trials, all conducted in high income countries, involving 4691 participants. Median sample size per group was 21. We examined the quality of each trial against eight standard criteria, and all trials were inadequate in relation to three or more of these standards. Trials evaluated contracts in addiction (10 trials), hypertension (4 trials), weight control (3 trials) and a variety of other areas (13 trials). Fifteen trials reported at least one outcome that showed statistically significant differences favouring the contracts group, six trials reported at least one outcome that showed differences favouring the control group and 26 trials reported at least one outcome without differences between groups. Effects on adherence were not detected when measured over longer periods.

Authors' conclusions

There is limited evidence that contracts can potentially contribute to improving adherence, but there is insufficient evidence from large, good quality studies to routinely recommend contracts for improving adherence to treatment or preventive health regimens.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Contracts between patients and healthcare practitioners for improving patients' adherence to recommended healthcare activities

Sometimes patients do not complete a course of treatment or they do not follow recommended changes in diet or personal habits. This poor adherence may be because treatments take a long time, have side effects or involve changing patients' habits, which is often difficult. Several interventions aim to change the relationship between patients and healthcare practitioners in order to improve the patients' adherence to treatments. One of these interventions is in the form of contracts between healthcare practitioners and patients, by which one or both parties commit to a set of behaviours related to the care of the patient. Contracts may be written or verbal. Most contracts are between healthcare practitioners and patients, but they may also occur between practitioners and carers, carers and patients or by a patient with him/herself. In this review we assessed whether contracts between practitioners and patients really improve the patients' adherence to treatment or their health status. We also assessed the effects of contracts on other outcomes, including patient participation and satisfaction, health practitioner behaviour and views, health status, harms, costs, and ethical issues.

We found 30 trials involving 4691 participants, examining several types of contracts. The main health problems targeted were substance addictions, hypertension and overweight. Many of the trials were of poor quality and involved small numbers of people. Most were conducted in the USA. In 15 of the trials there was at least one outcome showing statistically significant differences in favour of the contracts group (although some of the improvements in adherence did not remain when measured after a longer period). In six trials at least one outcome showed such differences in favour of the control group. In 26 trials there was at least one outcome for which there was no difference between the contract and control groups.

There is not enough reliable evidence available to recommend the routine use of contracts in health services to improve patients' adherence to healthcare activities or other outcomes.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

病人與醫護人員之間為了提升病人遵守治療的意願、預防疾病及增進健康的行為而做的協議

研究背景

病人為了保證屢行一連串與本身照護有關的行為,而跟自己、醫護人員或跟照顧者所做的口頭或書面的協議,協議的目的是為了提升病人遵守治療的意願或增進健康。

研究目的

評估病人與醫護人員之間,為了提升病人遵守治療的意願、預防疾病以及增進健康所做之協議的效用,協議中清楚載明要達成的健康或行為目標、病人滿意度或其它有關的成果,包含健康醫護人員的行為和觀念、健康情形、被揭發的傷害、費用或拒絕接受治療的結果。

检索方法

我們搜尋了:Cochrane Consumers and Communication Review Group's Specialised Register(2004年5月);Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library 2004年第1期);MEDLINE(1966年至2004年5月);EMBASE(1980年2004年5月);PsycINFO(1966年至2004年5月);同時也搜尋了CINAHL(1982年至2004年5月);Dissertation Abstracts. A: Humanities and Social Sciences(1966年至2004年5月);Sociological Abstracts(1963年至2004年5月);UK National Research Register(2000年至2004年5月)以及C2 SPECTR,Campbell Collaboration(1950年至2004年5月)。

纳入标准

我們納入了隨機對照臨床試驗來比對,醫護人員以及病人或照護者之間協議的影響。協議是應用於診斷程序(diagnostic procedures)、有益健康的食物療法(therapeutic regimens)或者任何健康的推廣活動、或是病人主動預防疾病。協議中必須具體說明至少一種觀察活動以及一個病人必須遵守的承諾。我們納入臨床試驗來比對協議以及常規護理或任何其他的介入措施。

数据收集与分析

由2位評論作家分別對臨床試驗的選擇與品質進行評估,而由另1位統計學家檢驗單一數據摘錄。我們以敘述性的方式,並將健康問題分組,來呈現不同的介入措施、參與者、背景以及結果。

主要结果

我們納入了30個臨床試驗,共有4691名個案參與研究,每組中位數(Median sample size)的樣本數為21,全部都是來自高所得國家。我們以8個標準納入條件來檢測比對所有臨床試驗的品質,在這8個標準納入條件中,沒有任何臨床試驗符合其中的3個或3個以上的標準。這些臨床試驗評估了有關成癮(10個臨床試驗)、高血壓(4個臨床試驗)、體重控制(3個臨床試驗)和其他不同範圍(13個臨床試驗)的協議。有16個臨床試驗結果顯示,至少有1項結果呈現統計上顯著性差異來支持實驗組別;有5個臨床試驗結果發現,至少有1項結果顯示有差異來支持控制組;其中有26個臨床試驗都顯示,至少有1項結果在2組之間沒有差異存在。當測量的期間過長時,就沒有發現病人與醫護人員間的協議,有任何提升病人遵守醫囑意願的效用。

作者结论

沒有足夠的證據可以證明協議有可能提升病人遵守醫囑的意願;但是從大型且品質好的研究中,並沒有發現充分的證據,足以建議病人跟醫護人員之間,為了提升病人遵守治療的意願或預防疾病而做一些相關的協議。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

病人與醫護人員之間為了提升病人遵守治療的意願、預防疾病及增進健康的行為而做的協議

病人與醫護人員之間,對於提升病人遵守醫護人員所建議之醫護行為所做的協議。有時候病人無法完成整個治療療程,或是不願意遵從醫護人員的建議,而改變飲食或個人生活習慣。這些行為可能是因為治療療程過長、有副作用發生或是很難改變長久以來的生活習慣。有些介入措施的目的是為了提升病人遵守治療的意願,而改變病人與醫護人員之間的關係。其中1種方法就是以醫護人員與病人之間所做的協議為形式,也就是其中1方或雙方保證履行一連串與病人照護有關的行為。大多數的協議是指病人與醫護人員之間,書面或口頭上的協定,也可能是醫護人員與照顧者、照顧者與病人之間,或者是病人與自己的一種協定。在這篇評論中,我們評估病人醫護人員間的協議,是否確實改善病人遵守治療的意願或病人的健康狀態。我們也評估協議在其他成果的效用,包含病人參與度與滿意度、醫護人員的行為與觀念、健康情形、健康損害、醫療成本,以及倫理上的議題。我們找到30個臨床試驗,總共有4619位參與者,來評估幾種型態的協議。主要是針對物質成癮、高血壓和體重過重等健康問題。有很多臨床試驗的品質不好且參與的人數不多,絕大部分的臨床試驗是在美國進行的。有16個臨床試驗顯示,至少有1項結果呈現有統計上顯著性的差異,來支持實驗組(雖然在測量過長的期間之後,提升病人遵守醫囑的意願並沒有持續)。其中有5個臨床試驗結果發現,至少有1項結果顯示差異來支持控制組。有26個臨床試驗都顯示,至少有1項結果發現實驗組與控制組之間沒有差異存在。目前沒有可靠證據證明,為了提升病人遵守醫護活動的意願,而定期訂立協議是有效的。

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