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Results of a recent survey from Statistics Canada1 described the Internet habits of Canadians. They showed that in 2005, 72% of Ontario residents, 71% of Alberta residents, and 69% of British Columbia residents used the Internet. More than 90% of adult home Internet users cited e-mail communication as a reason for using the Internet at home. It is likely that the other provinces of Canada will soon catch up and that in a few years nearly 100% of us will have access to the Internet at home.

Given this interesting social development, it seems prudent that health care services should capitalize on this relatively new way to access people. E-mail can provide a cheap and easy way to contact people about health care issues. Of course, primary care providers could contact their patients about such issues as drug renewal, annual health checks, and Pap tests. There has been little work, however, on active prevention of diabetes and cardiovascular disease with use of e-mail. One recent study has shown that weekly e-mail support provided by a dietitian helped obese individuals reduce their weight by up to 7.3 kg over 6 months.2

This method could be tried for various conditions needing lifestyle support. Diabetes is a good example of a chronic disease that could be better controlled by patient and health care provider e-mail dialogue. People with diabetes have better control over their disease when they are more empowered.3 With increasingly busy primary care clinics, e-mail for patient support could be developed into a system of its own. Patients with diabetes could check in with their family doctors at scheduled intervals and upload their hemoglobin A_Ic or fasting blood glucose levels and their weight (after near-patient testing). Glucometers could be attached to e-mail connections, and measurements could be downloaded to family doctors or nurse practitioners who could tabulate and graph results and work out future medication doses or exercise goals. Lifestyle advice could be personalized for these patients, and it might be possible to support patients to lose enough weight that their conditions disappearor at least become less troublesome. 4,5

More research in this area is needed, however, and issues of privacy of health information and how family physicians are to be paid for their time on the Internet contacting their patients will need to be worked through. Also, in order to maintain and build doctor-patient relationships, patients must expect to be able to come in and see their doctors occasionally. It is only a matter of time, however, before most people in Canada are using Skype-like technology to contact each other, and then family medicine will be far behind once again, trying to catch up.

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