We do it in a number of ways. Would you like me to comment on some first nations issues while we are on that? We have some specific strategies there as well, and we have done considerable work.
One way we do that is by knowing all the people in our jurisdiction who have diabetes or a particular chronic disease. We do this in the capital region. We basically, electronically, know who everyone is, and all their information is accessible. If we do that, and by interacting with the family physicians' electronic records, and by using strategies.... For example, we know that people who have diabetes must have a high blood sugar record somewhere in the laboratory that would be available electronically. So if we search through the laboratory, we can pick out all the people with diabetes. In fact, that is what we have been doing through the Canada Health Infoway project.
Because we have this integrated electronic system, we can then see that these people have diabetes. Have they visited a physician in the last year? Have they had the yearly urine test? If they haven't, we can remind them. We find that it is most beneficial and works best if we remind patients. We remind them by letter. If they don't respond after three letters, we can give them a phone call. And we have a community team that will even go knock on the door.
We use other strategies. Some of our community health nurses go to seniors' centres--there are about 47 of them in our region. They are there ostensibly to measure blood pressure and check blood glucose, but what they are really there for is to ask, while they're doing that, if there is anybody in the building or the centre who might be ill and who has not seen a doctor. We actually try to ferret out the patients.
We use community resources as well. Particularly with first nations, we rely, in the case of diabetes, for example, on people with diabetes serving as mentors to newly diagnosed patients. I have gone out on many trips. They will say that so-and-so is at home and has a problem with his foot. He has an ulcer on his foot. We will actually go out to the home and see him.
We really use the community and try to develop community spirit. We have various programs that develop patient empowerment, that get the communities empowered to look after each other. So there is a host of strategies we use to engage the public to pick out the people who don't go to physicians regularly.
In the inner city, we offer free lunch. Patients come in for the free lunch, and we capture them there for health care reasons.