A model-based framework for public health: a vehicle for maximising the value of telecare?

Information and communication technologies (ICT) play a pivotal role in enabling health care provision, particularly in the light of changes in delivery mechanisms which emphasise the primary and community sectors and embrace substitution policies that include home care, day care and call centres. However, the complexity of these systems means that it is difficult to determine the best ICT strategies to adopt in terms of efficiency and effectiveness. If public health strategies are to be devised so as to maximise the benefits of advances such as those in telemedicine and telecare, it is necessary to address the issues adopting an approach which is holistic and which encapsulates all causal relationships and influences. Conceptual models for such a systemic approach are developed using signed digraph and cybernetic feedback formalisms. The importance of addressing not only the needs of the population which are of public health concern, but also the factors giving rise to such needs is emphasised. The implications of this modelling approach are illustrated in the context of two telecare systems: home haemodialysis and Web-based services for the management of diabetes