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Health Promotion International, Vol. 18, No. 1, 67-77, March 2003
© Oxford University Press 2003

Using patient-driven computers to provide cost-effective prevention in primary care: a conceptual framework

Anthony P. Shakeshaft1,2,3 and C. James Frankish4

1Public Health Travelling Fellow, National Health and Medical Research Council of Australia, 2Visiting Scholar, Institute of Health Promotion Research, University of British Columbia, Vancouver, Canada, 3NHMRC Fellow, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia and 4Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada

Address for correspondence: Anthony P. Shakeshaft, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia, E-mail: a.shakeshaft{at}unsw.edu.au

SUMMARY

This paper initially presents a rationale for the cost-effectiveness of using patient-driven computers in primary care services. It specifically defines the concepts of prevention and primary care, prior to outlining the advantages of promoting the implementation of prevention practices in primary care. It argues that greater use of computer technology represents one means of cost-effectively optimizing the integration of prevention into routine primary care, and identifies an apparent disjuncture between the potential of computers and the limited success with which attempts to integrate them into routine primary care services have been met, as evidenced in the published international literature. Among several possible explanations for this disjuncture, such as a possible lack of precision with which computers identify at-risk patients, perceived high costs associated with computers and physicians’ concerns about the inflexibility and the more impersonal nature of computer interactions, is the apparent failure of researchers to utilize well designed and empirically tested models in the planning, implementation and evaluation of computerized care. An outline for such an approach, utilizing the Precede–Proceed model of health promotion planning and the Diffusion of Innovations theory, is presented.

Key words: computers; prevention; primary care


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