Occupational health receives too little attention in primary care settings; in addition, public health surveillance acquires and utilizes too little of the information available in clinical settings. Obtaining an appropriate occupational history requires both time and expert knowledge about occupational medicine, both of which are inadequate in most primary care settings. The DOKS (Distributed Occupational Knowledge System addresses these problems by developing a computer assisted system, which may be directly incorporated in routine primary health care delivery. It obtains a computer assisted occupational history and makes case specific recommendations for preventive interventions. It will also systematically collect clinical information for public health analysis. The system will be implemented in three different health ambulatory care settings- county hospital based, health maintenance organization, and clinic group. Initially, interviews will be in person, then by phone, and later by computer. Recommendations are provided to patients and clinical care providers. Evaluation includes historical and concurrent controls and is based on exit and 3 month interviews and record review. The process also yields valuable surveillance data including population segments often missed by other methods and describing functional impact of work rather than just occupationally caused disease.
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