Sometimes patients do not follow treatment or follow recommended dietary changes or personal habits. This poor adherence may be due to the fact that treatments take a long time, have side effects or change patients` habits, which is often difficult. Several interventions aim to change the relationship between patients and physicians in order to improve patients` adherence to treatment. One of these interventions is in the form of contracts between doctors and patients, where one or both parties commit to adopt a number of behaviours related to patient care. Contracts can be written or oral. Most contracts exist between physicians and patients, but they can also occur between practitioners and caregivers, nurses and patients or a patient with himself. In this audit, we examined whether contracts between practitioners and patients actually improve treatment fidelity or health status. We also assessed the impact of contracts on other outcomes, including patient participation and satisfaction, healer behaviour and perspective, health status, damage, costs and ethical issues. For this review, contracts are defined as any type of oral or written agreement by which one or both parties accept a number of behaviours related to the care of a patient. Contracts can be concluded between physicians and patients, between practitioners and nurses, between caregivers and patients, or by a patient with himself.
The contracts aim to improve compliance with treatment, prevention and health promotion measures. Two pairs of trials referred to the same studies, which presented data from two successive different periods: Piotrowski 1999 and Hartz in 1999 as a couple, Calsyn in 1994 and Saxon in 1996. The results of these studies are reported under the 1999 and Calsyn study codes in 1994. Schulman 1980 appeared to be based in the same environment as Swain in 1981, although it was not known whether the data analyzed came from the same group of patients. Currently, we have reported the results as two trials, but we want to clarify this in the future.