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.
Computer-Generated Written Behavioral Contracts with Problem Drinkers in Primary Medical Care.
Problem drinking is common among patients in primary medical care, but often unrecognized. Brief physician interventions can be helpful, but several barriers hinder their adoption in practice, notably a lack of time. We conducted a randomized pilot study of written behavioral contracts that patients wrote with help from a computer program. In eight family medicine practices, 2684 patients were approached and 2399 screened with the Alcohol Use Disorders Identification Test (AUDIT). Of those, 186 screened positive, 154 were eligible, and 80 enrolled. Follow-up interviews were completed with 69 (86%). At 12 months, the AUDIT and Addiction Severity Index alcohol scores decreased nonsignificantly more in the intervention group than in the controls. The study demonstrated that computer-based interventions are acceptable to patients and physicians, feasible in busy primary care practices, and have effect sizes comparable to those of physician-based interventions. Computer-based interventions may be an effective and efficient tool to enhance identification of and intervention with problem drinkers in primary care.