PROTAR

Health Promotion, Problem Targeting and Follow-up System

PROTAR is intended for targeting the attention of a family physician to the individual health problems and preventable conditions, health promotion and follow-up on the primary care level in the leading non-communicable diseases (NCDs).

The integrated approach promoted by the World Health Organization is adopted for the early detection and prevention of NCDs and health promotion since the epidemiologic research has shown the similarity of their risk factors: inactivity, obesity, disbalanced nutrition, arterial hypertension, smoking, alcohol abuse, etc . The health promotion component follows the approach of the Center for Disease Control in Atlanta, GA.

For more detail please contact
V. Olchanski by email volchans@vcu.edu

PROTAR provides for -

• direct computer collection of data on patient complaints, lifestyle and health disorders from patients;
• working out the individual recommendations for the family physicians (targeting) on the detected health disorders;
• working out the individual recommendations for the patient (health promotion);
• consequent tracking of the risk group patients.

PROTAR consists of three subsystems -

• An expert system targeting attention of the family physician to individual health problems.
• A statistical health promotion system of personal health risk assessment generating incentives for changing the lifestyle to improve health.
• A management information system for tracking the patients using an interactive problems status data base as the instrument of control which may be coupled with a family physician's Patient Record System or be expanded to a more complete health management information system.

The experts who designed the system were medical specialists from highly reputed national medical institutions specializing in various areas of non-communicable disease and in general medicine.

The medical experts worked under the direction of scientists in the theory of systems and management, and informatics.

This technique of computer aided detection of problems and risk group selection transfers the condensed knowledge of highly qualified medical experts in a form of a computer program for the use of ordinary family physicians, giving the advise and support in making diagnosis.

The average time of the patient-computer dialogue is not more than 20 minutes what is crucial to ensure the favorable reaction of patients.

For the physician, PROTAR prints out a list of complaints which explains the reasons why the problems have been indicated, a list of the detected health disorders, a list of the recommended target actions, and a feed-back slip for monitoring these actions.

For the patient, PROTAR presents the factors effecting the life expectation and in a persuasive manner suggests the changes in lifestyle that may improve the personal perspective.

All the recommendations and answers to the questions are stored in data base and are utilized for an individual patient follow-up as well as for monitoring the fulfillment of the recommended target actions.

The analysis of the information accumulated in the data base allows modification of the questionnaires and fine-tuning of the statistical and expert decision rules to the particularities of the attended population.

The earlier versions of PROTAR have been implemented in Russia since 1984 in a health center with 70,000 patients, on worksites of the Ministry of Nuclear Armaments, and in the Republic of Malta. The average through-put in the health center was about 100 patients a day.

The project was recognized at the Permanent National Exhibition of the Highlights of National Economy with 1 gold, 2 silver and several bronze medals in 1985.

PROTAR was implemented on personal computers under operating system MS-DOS. It creates database records in the industry standart dBASE-III format.

PROTAR may operate in any national language after the text of dialogue and the screen messages have been translated into this language. The User Manual in WordPerfect format giving more technical detail may be downloaded here. It was last edited in 1992.

Publications describing PROTAR concepts and evaluation:

1. A.Petrovski, V.Olchanski, L.Manoukian. Computer-aided Health Surveillance System - ASKIS. In: R.Salamon, B.Blum M.Jorgensen (Eds) MEDINFO-86. 5th World Congress on Medical Informatics, Washington, D.C., USA, 1986. Pt.1. P.319-321.
2. A.Mazovetsky, V.Olchanski, A.Petrovski. Integrated Primary Health Care in the USSR: an Innovative Approach. Bull. of International Diabetes Federation. Vol.XXXI, No.3, November 1986, P. 106-108.
3. L.Chazova, A.Kalinina, V.Ivanov, E.Markova. Active detection of persons with ischaemic heart disease, arterial hypertension and with risk factors by population mass screening. Directives of the USSR Health Ministry. M., 1987. (In Russian)
4. A.Petrovski, L.Manoukian, V.Olchanski, et al. Some Approaches to Improve Population Health Care. Sovetskoe Zdravoohranenie (Soviet Health Care), No.8, 1988, P.32-37. (In Russian).
5. A.Petrovski, V.Olchanski, L.Manoukian, A.Mazovetsky, V.Timonin, J.Azzopardi. FOR YOU - A Practical System for Early Detection and Risk Group Follow-up in Non-communicable Diseases. In: INFORMATICA'88, International Conference on Informatics in Health sponsored by UNESCO, IBI, IMIA, Government of Cuba. 15-18 February 1988, Habana, Cuba. Vol.3
6. A.Mazovetsky, V.Olchanski, A.Petrovski, Z.Junoussov. FOR YOU - Integrated Population Health Screening and Follow-up Expert System in Diabetes Mellitus and Other Non-Communicable Diseases. 13th International Diabetes Federation Congress. Sydney, Australia, November 1988.
7. E.Markova, L.Chazova, A.Petrovski, L.Dartau, R.Mochachvili. The first verification test of the computer-assisted system ASKIS in ischaemic heart disease detection. Therapeutic Archive. Vol.61, No 9, 1989. (In Russian).
8. Y.Sountsov, A.Mazovetsky, V.Olchanski, et al. Using a Questionnaire in Diabetes Mellitus Surveillance in Population. Problems of Endocrinology (Problemy endokrinologii), 1987, V.33, No.2.
9. Z.Junoussov, A.Mazovetski, V.Olchanski et al. Using Logical Decision Rules for Making-up Diabetes Mellitus Risk Groups. Problems of Endocrinology (Problemy endokrinologii), 1990, V.36, No.6
10. J.Azzopardi, A.Mazovetski, V.Olchanski, Z.Junoussov, F.Fenech. A Test of Integrated Population Health Screening and Follow-up System in Diabetes Mellitus and Other Non-communicable Diseases. 1st Maltese Medical School Conference, December 1989, Malta.
11. E. Hutchins (Ed.) Healthier People. Health Risk Appraisal Program. Carter Center of Emory University, Atlanta, GA, July 1991.
12. Y.Komarov, V.Olchanski. Documentation and Information / Knowledge Support for Family Doctor. 3rd German Conference of Medical Documentalists. March 1992, Hanover, Germany.
13. V.Olchanski. On the design of an information/knowledge support system for primary health care. MEDINFO-92 World Congress on Medical Informatics, Pt. 1, P.362, Geneva, Switzerland, September 1992
14. V.Olchanski. Information/knowledge support for family doctor. 5th International Conference on Systems Science. Prague, Czecho-Slovakia, July 1992.
15. J.Azzopardi, F.Fenech, Z.Junoussov, A.Mazovetsky, V.Olchanski. A computerized health screening and follow-up system in diabetes mellitus. Diabetic Medicine, J. British Diabetic Association, Vol. 12, p. 271-276, 1995

V.Olchanski