Patient Contracts for Chronic Medical Conditions: Scoping Review

Overview

Journal Can Fam Physician

Specialties General Medicine
Public Health

Date 2022 May 13

PMID 35552216

Authors

Erin Gallagher

Elizabeth Alvarez

Lin Jin

Dale Guenter

Lydia Hatcher

Andrea Furlan

Affiliations

Soon will be listed here.

Abstract

Objective: To describe how and why patient contracts are used for the management of chronic medical conditions.

Data Sources: A scoping review was conducted in the following databases: MEDLINE, Embase, AMED, PsycInfo, Cochrane Library, CINAHL, and Nursing & Allied Health. Literature from 1997 to 2017 was included.

Study Selection: Articles were included if they were written in English and described the implementation of a patient contract by a health care provider for the management of a chronic condition. Articles had to present an outcome as a result of using the contract or an intervention that included the contract.

Synthesis: Of the 7528 articles found in the original search, 76 met the inclusion criteria for the final review. Multiple study types were included. Extensive variety in contract elements, target populations, clinical settings, and cointerventions was found. Purposes for initiating contracts included behaviour change and skill development, including goal development and problem solving; altering beliefs and knowledge, including motivation and perceived self-efficacy; improving interpersonal relationships and role clarification; improving quality and process of chronic care; and altering objective and subjective health indices. How contracts were developed, implemented, and assessed was inconsistently described.

Conclusion: More research is required to determine whether the use of contracts is accomplishing their intended purposes. Questions remain regarding their rationale, development, and implementation.

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