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 prospective study of the effect of education on non-compliant behaviour in contact lens wear.
The contact lens practitioner and patient present a specific case for the study of non-compliance in areas such as hygiene, solution use, appointment attendance and wearing times. Education is one of the factors thought to influence compliance among patients in general health care situations and contact lens practitioners are encouraged to educate patients in the care and maintenance of contact lenses. A prospective, randomized, controlled and double masked study was performed to assess the effect of a 'compliance enhancement strategy' on levels of compliance among contact lens wearers over twelve months. Eighty experienced contact lens patients were randomly allocated to two experimental groups. A standard level of contact lens instruction was applied to the first group and in addition the compliance enhancement strategy was applied to patients assigned to the second group. The strategy consisted of extra education for patients using a video, booklets, posters, a checklist and a health care contract. Patients were given free supplies of ReNu multipurpose solution and Medalist 38 soft contact lenses (Bausch and Lomb, Rochester, New York). Compliance levels were assessed at a twelve month aftercare appointment by demonstration and questionnaire. The results indicate that the compliance enhancement strategy had little significant effect on the compliance levels of the patients to who it was applied. The population of contact lens wearers were generally very compliant and the contact lenses and care regimen were clinically successful. The possibility that the assessment of non-compliance was not adequately sensitive to highlight small differences in non-compliant behaviour is discussed. The standard level of education applied to this sample of contact lens patient were adequate to ensure generally high levels of compliance with the simple care and maintenance regimen recommended.