Patients or their caregivers, of any gender and age, with any health condition and in any health environment. The term “patient” is commonly used to refer to anyone undergoing diagnostic tests or treatments or participating in disease prevention or health promotion initiatives. In Piotrowski 1999, the proportion of participants in the contract group who were abstinent after 120 days of treatment showed no difference from the control group (measured by samples without substance). (See Analysis 1.2). In an emergency, when a decision needs to be made urgently, the patient is unable to participate in the decision-making process, and the patient`s surrogate mother is not available, physicians can initiate treatment without prior informed consent. In such situations, the physician should inform the patient/surrogate mother as soon as possible and obtain consent to continued treatment in accordance with these guidelines. In Aragona 1975, participants in the contract group lost more weight than those in the control groups, both at the end of treatment (-11.3 pounds in the intervention group versus -9.5 and +0.5 pounds in the control groups) and after 8 weeks of follow-up (-7.9 pounds in the intervention group versus -5.0 and +3.6 pounds in the control groups). Although this review focuses on a single strategy related to each health condition, several systematic reviews have assessed interventions to improve compliance or compliance with certain conditions. Five included contracts. One of them was limited to meeting deadlines and considered only randomised controlled trials in English (Macharia, 1992).
Another evaluated controlled study, published in English-language journals, on patient adherence to treatment regimens (Roter 1998). Three other reviews were published in the Cochrane Library. One focused on tuberculosis (Volmink 2006), another on commemorative packaging (Heneghan 2006) and another on adherence to prescribed (self-administered) medications (Haynes 2008). No systematic review has treated contracts as a strategy to improve patient adherence to any type of treatment, prevention or health promotion activities, regardless of attitude and condition or disease affecting patients. Patient participation in the contracting process (e.B. Inclusion of patient values and preferences) and the degree of joint decision-making when alternative treatment options are available, which are assessed by qualitative statements or scales. Low adherence can seriously impair the effectiveness of therapeutic therapies. It has been reported that appointment adherence can be as high as 10% (number of appointments held out of the total number of scheduled appointments), or in the case of long-term medication adherence, it can be as high as 40% to 60% (percentage of patients with medication in body fluids or self-assessment of medication reporting) (Sackett 1979). Poor adherence to treatment regimens has been associated with reduced treatment effectiveness, resulting in poorer health outcomes and even death (Cleemput, 2002; Gordis, 1979; Simpson, 2006).
The World Health Organization (WHO) report on blood adherence documents the poorer outcomes associated with poor adherence in conditions such as high blood pressure, type 2 diabetes and depression (WHO 2003). There is evidence that the costs associated with treating non-adherent patients are higher than the costs associated with treating adherent patients (Cleemput, 2002; Heinssen, 1995). In the United Kingdom, it is estimated that missed appointments result in an economic loss of £250 million per year (DPP 2003). However, adherence to potentially harmful treatments can also lead to adverse outcomes (Simpson, 2006). The wives of the participants who observe and record whether disulfiram (Antabuse) has been taken by their husbands, and in turn, they avoid mentioning fears of their husband`s future consumption, with instructions on when to consult a doctor (O`Farrell 1984). Recording of disulfiram consumption (Antabuse), which was sent monthly to the treatment program (Keane 1984). There are other critical factors to consider when deciding whether to introduce contracts within a health system. The included studies addressed little or no of these factors, namely: acceptance of contracts for health professionals; participant, patient and caregiver satisfaction; costs; clinician responsibility, maintaining stigma in patients (Fishman, 2002b); and ethical considerations, particularly if treatment depends on patients who adhere to the terms of the contract, or if financial rewards are used. Some of the findings in the protocol for this review related to issues such as patient participation in the contracting process, the degree of joint decision-making, harm or ethical issues; but none of the studies reported data on them. The lack of reporting on consumer participation underscores the provider-centred approach, where compliance is primarily seen as a patient obligation and practitioners remain in a condescending role; far from the concordance model. This may be due in part to the fact that most of the studies were conducted more than a decade ago. Future studies should also address the issue of damage.
We saw in Hoelscher in 1986 that the Group of Treaties had achieved less good results in terms of compliance with relaxation practices. However, contracts can also reduce patient retention rates or affect the sincerity with which patients report events that could violate the terms of the contract. The three high blood pressure studies that reported blood pressure results showed no difference between groups in blood pressure measurements (with the exception of better diastolic blood pressure in the contract group in Swain in 1981). Adherence outcomes in the contract groups were both better (Swain, 1981) and worse (Hoelscher, 1986) than in the control groups. Hypertension-related contracts appear to be relatively unexplored, although blood pressure control in many countries falls far short of treatment goals and the recognized relevance of behavioural interventions to achieve these goals (Réunion 2006). The evidence from the included studies supporting the use of contracts for high blood pressure was very weak. Four of the seven studies on alcohol or opiate dependence reported statistically significant differences in several outcomes that favoured the contract group. The results of Miller`s review (Miller 2002) ranked behavioral contracts as one of the top 10 treatment modalities (out of 46) for alcohol abuse (although significant publication bias could not be excluded in this review).
However, some of these positive effects observed in our review were not consistent across all repeated measures over time. We were unable to identify one study that examined the effects of opioid contracts in treating opioids to relieve chronic pain. Contracts widely used but of dubious effectiveness (Fishman, 1999). McLean in 1973 studied the impact of contracts and training in social learning principles on changing the behavior of patients and their partners. Participants in the contract group showed a significant improvement in targeted behaviour per 3 months of follow-up compared to those treated regularly, as well as a decrease in negative reactions at the time of treatment end. (See Analysis 5.1 and Table 11). A new outcome related to the use of services, which was not foreseen in the protocol phase, is reported here. The contracts significantly increased the discharge rate of patients on methadone treatment (Calsyn, 1994), as the contingency contraction in this study involved discharge for continuous positive urinalysis.
In other words, the contracts were not able to keep patients on treatment, but participants in the contract group were statistically significant less months before treatment resumed (i.e., they were readmitted after a shorter period of time than participants in the control group). We extracted the following outcome data (for all parties, para. B example for children and parents): measures of adherence to therapeutic therapies and use of services; compliance with the terms of the contract by health professionals; penalties and rewards; quantitative measures or qualitative data describing the degree of joint decision-making; measures of satisfaction with the process; expectations and psychological stress; the understanding and conduct of health professionals with respect to contracts; health status data, para. B improvement in clinical parameters or prognosis; cost information detailing (where possible) how the costs were estimated; and data on damages resulting from compliance or non-compliance with the treatment(s). Litzelman in 1993 and Morgan in 1988 studied the effects of contracts on the prevention of diabetes-associated lower limb abnormalities (musculoskeletal and dermatological) and on the treatment of type II diabetes, respectively. Litzelman 1993 results included adherence results (e.g., B foot washing), health outcomes (e.g., B presence of plantar lesions) and results in the physician`s office (e.g.B documentation of clinical observations). .