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.
Active patient orientation.
The successful treatment of chronic ambulatory illness requires that patients be involved actively in the management of their own conditions. How health providers orient services toward patients is likely to affect the quality of patients' involvement. In the study reported here, three programs of care were evaluated in terms of the extent to which the care provided was oriented toward patients as active participants in the treatment process. Ninety-one hypertensive patients, randomly assigned among the three programs, rated their care in terms of active patient orientation (APO). On the basis of the structural characteristics of the three programs, it was hypothesized that the contingency-contracting approach would afford a stronger APO than either the educational or routine-care approach. The findings conform to expectation. Observed linkages among structure of care, level of APO reported, and patient participation are discussed in addition to the practice implications.