Contracts between patients and healthcare practitioners for improving patients' adherence to treatment, prevention and health promotion activities

Bosch‐Capblanch, Xavier; Abba, Katharine; Prictor, Megan; Garner, Paul

doi:10.1002/14651858.cd004808.pub3

Cited by 103 publications

(112 citation statements)

References 133 publications

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“…These titles and abstracts were reviewed again and it was felt that it was unlikely that they would be of relevance to the final review thus, in view of this and the rapid nature of this meta-review, they were excluded on this basis. After full-text screening, there were 10 systematic reviews included in this quantitative review 99,[168][169][170][171][172][173][174][175][176] (see Figure 33).…”

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

“…The year of review publication ranged from 1998 170 to 2011 176 and included RCTs dating from 1973 to 2010, published in peer-reviewed journals. Total numbers of participants in the RCTs were not synthesised in several of the reviews, but we were able to calculate that they ranged from 382 168 to more than 87,000 171 (in which the number of participants in all RCTs was not given). Of the 10 reviews, six presented statistical estimates from aggregated data and the remaining four presented data synthesised narratively alone.…”

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

“…Half of the reviews (five) were classified as being of higher quality (R-AMSTAR ≥ 31), 99,168,169,174 whereas five were classified as lower quality (R-AMSTAR ≤ 30) 170,172,173,175,176 ( Table 78).…”

Section: Quality Assessment and Weightingmentioning

confidence: 99%

“…Bosch-Capblanch et al 168 focused on contracts as a support intervention to improve people's adherence to treatment. These trials predominantly utilised education, behavioural strategies, relaxation techniques and BP monitoring, delivered in group settings that were supported by the use of contracts.…”

mentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

337

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Systematic Reviews Identifiedmentioning

confidence: 99%

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

Section: Quality Assessment and Weightingmentioning

confidence: 99%

mentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

337

451

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“…Al encontrar una base común con los pacientes en el proceso de la toma de decisiones trae como consecuencias la disminución en la derivación de pacientes, menos visitas posteriores y menos exámenes de laboratorio o imágenes 3 . No obstante, aún cuando la toma de decisión está formalizada a través de un "contrato" entre el médico y el paciente, no se ha demostrado una mejoría significativa en la adherencia al plan de manejo a largo plazo 19 .…”

Section: Tabla 1 Metas De La Comunicación Médicaunclassified

La comunicación médico paciente: ¿Cuáles son las habilidades efectivas?

et al. 2010

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Effective Communication Skills form part of what is being a good doctor. There is a solid evidence base that defines the components of effective communication. This article offers a practical conceptual framework to improve physician-patient comFax: 518 6760 e-mail: moore@med.puc.cl E l éxito de cualquier entrevista clínica depende de la calidad de la comunicación médico-paciente. Las habilidades comunicacionales efectivas son parte del quehacer de un buen médico y por lo tanto, la comunicación es considerada una de las competencias básicas en la formación médica. Por esta razón se han incluido cursos formales de comunicación médica en los currículos de las escuelas de medicina de la mayoría de las universidades 1,2 .Con el uso de habilidades de comunicación efectiva, se busca aumentar la precisión diagnósti-ca, la eficiencia en términos de adherencia al tratamiento, y construir un apoyo para el paciente. Una comunicación efectiva promueve la colaboración entre el médico y el paciente, donde el foco de la entrevista no está centrado en el médico ni en el paciente, sino en la relación de ambos.Parte importante del aprendizaje de cualquier competencia es la definición clara que desglosa sus componentes: conocimientos, habilidades y actitudes. Hoy existe una base sólida de evidencia que aporta al conocimiento de cuáles son los componentes de una comunicación efectiva en medicina. El presente artículo resume esta evidencia y describe las habilidades comunicacionales básicas que permiten crear una efectiva comunicación médico paciente.

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