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.
A comparison of compliance techniques on the control of high blood pressure.
Four compliance strategies were compared with education alone to investigate their impact on the control of high blood pressure. One hundred twelve subjects with documented high blood pressure were randomly assigned to receive education alone, home blood pressure monitoring, contracts, pill packs, or a combination of techniques. Groups were similar in terms of age, sex, race, initial blood pressure, and medications. At the end of the year, there was no significant change in blood pressure for the group that received education alone (-3/-1 mm Hg). There was a statistically significant change in both systolic and diastolic blood pressure for all compliance groups (-17/-10 mm Hg). Information from compliance questionnaires adds further support to the observation that education alone does not influence compliance while the specific techniques studied did improve compliance. The study was too small to show any difference among techniques.