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

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.