CMAJ 1997;157:121
© 1997 Canadian Medical Association
Hepatitis B vaccine, although highly effective, is difficult to administer. It requires 3 injections, given at 0, 1 and 6 months. Many patients do not complete the schedule, which results in markedly decreased vaccine effectiveness and a waste of valuable resources. John Sellors and colleagues at McMaster University report the results of their randomized trial of a compliance enhancement strategy for patients who failed to return for the second dose (page 143). Of those who received a reminder letter, 25% returned. The simple measure of supplementing the letter with a telephone call nearly doubled this rate, to 48%. Although this result is far from perfect, it serves to remind us that effective interventions don't have to be expensive.
The Commission of Inquiry on the Blood System in Canada (Krever inquiry) recommended that hospitals across the country review their records, identify former patients who received blood or blood components between 1978 and 1985, and directly notify these patients that they may have been exposed to HIV. The commission also recommended that patients who received blood between 1978 and 1990 (when screening for hepatitis C virus began) should be notified of their possible exposure to HCV. Is this feasible? Few Canadian hospitals have accepted the challenge. Nancy Heddle and colleagues report on a look-back notification program at ChedokeMcMaster Hospitals in Hamilton, Ont. The program targeted patients who received blood or blood products between 1978 and 1985 at age 16 or younger (page 149). A third of the 1546 patients could not be contacted. Of the remainder, almost a third were unaware they had received a transfusion during their hospital stay.
Susan King at the Hospital for Sick Children in Toronto reviews look-back notification efforts in Canada and describes their key goals (page 155). She argues that in addition to addressing the specific objectives of case finding, informing patients of their transfusion history, and providing information about risks and testing, such programs develop and maintain the public's trust in health care professionals and their institutions. We agree. Even though the costs are not trivial, the stakes are high and extend beyond simple calculations of disease frequency and cost per case detected.
Physicians need to encourage patients to sign organ-donor cards. Tat-Ying Wong
recounts his family's experience of waiting for a donor heart for their infant daughter (page 172). Diagnosed with cardiomyopathy, Janice waited months for a new heart. Why is there a shortage of donor organs? Eike-Henner Kluge urges physicians and transplant societies in Canada to respect as binding a person's signed consent to become an organ donor in the event of his or her death (page 160). All too often, transplant societies require the additional consent of the donor's next of kin -- an ethically unnecessary step, in Kluge's view, that leads to a vast loss of life-saving organs. -- JH
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Editor's preface