In 1997, Claydon studied the effects of a combined intervention of contracts, teaching materials (poster, video) and reminders on contact lens maintenance behaviors against routine care. There was no difference between groups in any of the targeted behaviours. (See also Table 11). According to specific behaviours towards partners (McLean, 1973). Contracts were concluded mainly between two parties: between participants or patients and doctors in seven studies (23%), between participants or patients and carers, peers or other significant carers in nine studies (30%) and between doctors and carers in one study (3%). In four studies (13%), contracts were tripartite between patients, caregivers and physicians. Two studies (7%) examined a self-contract. In the other seven studies (23%), the parties involved in the contracts were not notified. For more details on each study, see the table `Characteristics of included studies`. In Swain in 1981, contracts significantly improved patients` knowledge of high blood pressure problems. Participants` opinions on health care were studied in one study (Schulman 1980) using patients` active referral scores (healthcare professionals support patient motivation and increase their active participation, disease management is collaborative, clear instructions and skills training). Contract patients rated their care significantly higher in patients` active referral scores. At Hoelscher in 1986, the cost-effectiveness ratio (improvement in blood pressure per hour of therapist contact) was significantly higher in the « group loosening contracts » group than in the « individual relaxation » group.
Since this audit was not limited to a particular disease, we sought input from consumers or patients whose health experience was not limited to a single group of diseases and who had experience or involvement in issues related to the relationship between patients and physicians. Consumer participation was ensured during the minutes phase and the evolution of the revision and will be taken into account in future updates. McLean studied in 1973 the impact of contracts and training on social learning principles on the changing behavior of patients and their partners. Compared to those treated routinely, participants in the group showed a significant improvement in targeted behaviour up to 3 months of follow-up and a decrease in negative reactions at the time of treatment end. (See Analysis 5.1 and Table 11). Some contracts depend on a relational model. Contrary to what was thought in a concurring report, the doctor`s perspective prevails in the literature on behavioral contracts studied so far. In general, there is no guidance on the obligations of health professionals (such as providing evidence-based information or treatment). Often, contracts do not appear to be based on a relationship characterized by joint decision-making, but they put the responsibility for the failure of contractual terms on the side of patients. .