Post-policy Implementation Research Articles

An evaluation of the National Institutes of Health Early Stage Investigator policy: Using existing data to evaluate federal policy.

To assist new scientists in the transition to independent research careers, the National Institutes of Health (NIH) implemented an Early Stage Investigator (ESI) policy beginning with applications submitted in 2009. During the review process, the ESI designation segregates applications submitted by investigators who are within 10 years of completing their terminal degree or medical residency from applications submitted by more experienced investigators. Institutes/centers can then give special consideration to ESI applications when making funding decisions. One goal of this policy is to increase the probability of newly emergent investigators receiving research support. Using optimal matching to generate comparable groups pre- and post-policy implementation, generalized linear models were used to evaluate the ESI policy. Due to a lack of control group, existing data from 2004 to 2008 were leveraged to infer causality of the ESI policy effects on the probability of funding applications from 2011 to 2015. This article addresses the statistical necessities of public policy evaluation, finding administrative data can serve as a control group when proper steps are taken to match the samples. Not only did the ESI policy stabilize the proportion of NIH funded newly emergent investigators but also, in the absence of the ESI policy, 54% of newly emergent investigators would not have received funding. This manuscript is important to Research Evaluation as a demonstration of ways in which existing data can be modeled to evaluate new policy, in the absence of a control group, forming a quasi-experimental design to infer causality when evaluating federal policy.

Health, Secondhand Smoke Exposure, and Smoking Behavior Impacts of No-Smoking Policies in Public Housing, Colorado, 2014–2015

IntroductionExposure to secondhand smoke is problematic for residents living in multiunit housing, as the smoke migrates through shared ventilation systems, unsealed cracks, and door spaces. The objective of our research was to assess resident exposure to secondhand smoke, support for no-smoking policies, and the health impacts of no-smoking policies in multiunit housing.MethodsSurveys of 312 heads of households who resided in 1 of 3 multiunit buildings managed by a Colorado public housing authority were administered before and after implementation of a no-smoking policy that prohibited smoking in all resident apartments and all indoor common areas. A matched-pairs analysis of initial surveys and 15-month post-policy implementation surveys for 115 respondents was conducted.ResultsDecreases were found in the number and percentage of smokers who smoked every day and the number of cigarettes smoked per day, and 30% had quit smoking 15 months after policy implementation. The percentage of residents who smelled secondhand smoke indoors declined significantly. A significant decrease in breathing problems was found after policy implementation. Although decreases were found in the incidence of asthma attacks, emphysema/chronic obstructive pulmonary disease, eye irritation, colds, nasal congestion, and ear/sinus infections, these decreases were not significant.ConclusionConsistent findings across nearly all variables tested suggest that no-smoking policies reduce resident exposure to secondhand smoke, lower the incidence of secondhand smoke–associated breathing problems, decrease daily smoking and cigarette consumption, encourage smoking cessation, and increase quit attempts. If implemented in all multiunit housing, these policies could reduce exposure to secondhand smoke and health problems associated with secondhand smoke, promote smoking cessation, and reduce cigarette consumption.

Affirmative Action, School Composition and School Outcomes: Evidence from India

This thesis is an empirical investigation of the affirmative action (quota-based reservation) policies stipulated in the Right of Children to Free and Compulsory Education Act (RTE, 2010), India. Using nationally representative, cross-sectional data from two rounds of the Indian Human Development Survey (IHDS) that precede (2004-05) and succeed (2011-12) the enactment of the RTE, I examine 1) the motivation for these reservation policies and 2) whether their performance is equity-enhancing. I explore motivation by checking for socio-economic differences between students in public and private elementary schools. Furthermore, I investigate whether such stratification, if present, poses a disadvantage to either of the student groups by studying the relative effectiveness of these schools in generating learning outcomes. To assess performance, I explore the temporal evolution of the aforementioned socio-economic stratification by school type, before and after the policy implementation. I find evidence of student stratification across public and private schools, but inconclusive indication of a ‘private school premium’ on learning outcomes as measured by test scores. While scores in Hindi reading and math are significantly higher in private schools, it is unclear if the school type itself drives this difference. Performance-wise, I observe that several of the existing gaps in socio-economic characteristics have either persisted or diverged post policy implementation, implying poor performance. Determining the drivers of these findings is crucial for definitive conclusions. Additionally, results must be gauged with caution, as the methods employed here do not entirely allay concerns of unobserved heterogeneity.

Post-Policy Implementation Review of Rapid Fetal Fibronectin (fFN) Testing for Preterm Labour in Alberta.

In 2006, the Alberta Ministry of Health issued a policy to implement fetal fibronectin (fFN) testing as a publicly funded service for pregnant women. The goals were to reduce maternity health care utilization and unnecessary treatment, which would result in cost-savings for the health system by more accurately diagnosing false preterm labour. We conducted a post-policy implementation review to determine whether the policy implementation achieved its goals. We assessed the impacts of fFN testing on clinical decision-making for ambulance transfer, hospital admission, and length of hospital stay by comparing these variables between the tested and untested patients. This post-implementation analysis was conducted separately for inpatients and outpatients and for true and false preterm labour, using multilevel regressions with episodes or visits being nested within patients. We then assessed the impact of fFN testing on costs to the health system by using decision-tree models populated with actual data and results from the regressions. The additional information, provided by fFN testing, influenced clinical decision-making. However, physicians placed a greater significance on positive test results than on negative results, which resulted in an inadvertent increase in health care utilization. After including the costs of fFN testing, the total cost to the system increased by $4.2 million (in 2014 Canadian dollars) between 2008 and 2013, with contributions of $700 000 for false labour and $3.5 million for true preterm labour. The policy to adopt fFN testing in Alberta did not achieve the intended aims of reducing unnecessary health care utilization to achieve cost-savings for the health system. There was an inherent tendency to err on the side of caution, and physicians were influenced more by positive test results.

Clamp late and maintain perfusion (CLAMP) policy: delayed cord clamping in preterm infants

Objective: Randomized controlled trials have demonstrated that delayed umbilical cord clamping (DCC) in preterm infants results in improved neonatal outcomes, including increased hematocrit, and decreased rates of intraventricular hemorrhage (IVH) and packed red blood cell transfusions. We hypothesized that implementation of a DCC policy in preterm infants would result in similarly improved outcomes, despite initial clinician resistance.Study design: A DCC policy (30–60 s) for singleton infants <35 weeks gestation was implemented in September 2011. We conducted a pre-test/post-test analysis of neonatal outcomes among singletons delivered between 24 0/7 weeks and 34 6/7 weeks gestation from 2009 to 2013 (2 years pre-implementation and 2 years post-implementation). The primary outcomes were rates of policy compliance and four neonatal outcomes.Results: Despite multiple routes of policy dissemination, DCC was attempted in only 49% of the deliveries. In spite of this, infants delivered post-policy implementation (n = 196) had a significant decrease in IVH, significant increase in initial hematocrits, and improved temperatures compared with infants delivered pre-implementation (n = 204).Conclusion: After implementation of a DCC policy, preterm singleton infants had improved temperatures, increased hematocrits and a decreased prevalence of IVH without significant differences in adverse outcomes, suggesting that the benefits of DCC outweighed the risks.

Smoking, attitudes to smoking and provision of smoking cessation advice in two teaching hospitals in Ireland: do smoke-free policies matter?

Brief cessation advice from health-care professionals in the hospital setting significantly increases the likelihood of patients quitting smoking, yet patients are not routinely provided with this advice. Smoke-free hospital policies aim to protect individuals from the adverse effects of smoking; however, it is unclear if such policies encourage systematic delivery of cessation advice by health-care professionals. The study's aim was to determine the prevalence of smoking and cessation advice received by in-patients in two teaching hospitals in Ireland which have implemented smoke-free hospital policies, and to examine patient attitudes towards smoking cessation. Change in smoking prevalence and delivery of smoking cessation advice prior to and post-policy implementation was also examined in one hospital. This study surveyed 466 in-patients across 2 hospital sites, over a 3-week and 5-week period, respectively. Data were also compared to a survey completed prior to the implementation of the smoke-free policy in one of the hospital sites. Smoking prevalence was 17% in Beaumont Hospital and 28% in Connolly Hospital. Overall, nicotine dependence was low (Mean Fagerström Test for Nicotine Dependence = 4.21, ±2.9). Overall, 62% of smokers did not receive smoking cessation advice from a health professional, although 55% indicated a willingness to engage with this type of service. The before-and-after analysis of Beaumont Hospital showed a reduction in smoking prevalence (17% vs 21%) amongst hospital in-patients, and a 6% increase in reported cessation advice provided following the introduction of the hospital smoke-free policy. Smoke-free hospital policies play a role in decreasing the prevalence of in-patient smokers, but further intervention is needed to increase rates of cessation advice provided. Positive attitudes to smoking cessation, coupled with low average nicotine dependence, suggest that low-intensity interventions would be beneficial for most smokers. A systematic focus on provision of brief smoking cessation advice is needed in hospitals.

The Effect of Mandatory Audit Firm Rotation on Audit Quality and Audit Fees: Empirical Evidence from the Korean Audit Market

SUMMARY: Using a unique setting in which mandatory audit firm rotation was required from 2006–2010, and in which both audit fees and audit hours were disclosed (South Korea), this study provides empirical evidence of the economic impact of this policy initiative on audit quality, and the associated implications for audit fees. This study compares both pre- and post-policy implementation and, after the implementation of the policy, mandatory long-tenure versus voluntary short-tenure rotation situations. Where audit firms were mandatorily rotated post-policy, we observe that audit quality (measured as abnormal discretionary accruals) did not significantly change compared with pre-2006 long-tenure audit situations and voluntary post-rotation situations. Audit fees in the post-regulation period for mandatorily rotated engagements are significantly larger than in the pre-regulation period, but are discounted compared to audit fees for post-regulation continuing engagements. We also find that the observed increase in audit fees and audit hours in the post-regulation period extends beyond situations where the audit firm was mandatorily rotated, suggesting that the introduction of mandatory audit firm rotation had a much broader impact than the specific instances of mandatory rotation. Data Availability: Most of the financial data used in the present study are available from the KIS Value Database. The data for audit hours and fees were drawn from statements of operating results filed with the Financial Supervisory Services (FSS) in Korea.

The impact of clinical pharmacist and ID intervention in rationalization of antimicrobial use

What is known and objectiveThere is little research on the impact of implementing and monitoring antimicrobial policy in Saudi hospitals. The purpose of this study is to measure the impact of the clinical pharmacist (CP) and infectious disease consultant (ID) interventions on the use of three antimicrobials (caspofungin, imipenem, meropenem) in hospitalized patients in the King Abdullah Medical City hospital. MethodsThe study was carried out in the King Abdullah Medical City, in Mekkah, Saudi Arabia. The hospital is a tertiary center that provides CCU, CSICU, Cardiac, Hematology, ICU, Medical, Neuroscience, Oncology, and specialized surgery services. The use of three antimicrobials (caspofungin, imipenem, meropenem) was reviewed by the clinical pharmacist for four periods, pre and post implementation of policy. Relevant data were collected in four periods. In the first period, before policy implementation, data were collected retrospectively to be used as baseline status reference, and in the three remaining periods that followed data were collected prospectively, and compared to baseline data, to evaluate the role of clinical pharmacist and ID interventions in optimizing antimicrobial therapy. Results and discussionCaspofungin duration of therapy was not affected significantly by the intervention. Statistically significant reduction in antimicrobial therapy duration was observed in imipenem (37%) and meropenem (37%) from baseline, which indicate a better control on antimicrobial use and reduction in antimicrobial resistance. What is new and conclusionThe impact of the clinical pharmacist and ID interventions, in reducing antimicrobial therapy duration using imipenem and meropenem, is clear from the result presented above. However, lack of restriction and follow up in the antimicrobial policy in case of negative culture makes antimicrobial use uncontrollable in these cases. Establishing good and accepted policy may help reduce consumption and total cost of therapy.

Initial impact of Medicare's nonpayment policy on catheter-associated urinary tract infections by hospital characteristics

Aims and objectivesThe goal of this study was to evaluate the trend in urinary tract infections (UTIs) from 2005 to 2009 and determine the initial impact of Medicare's nonpayment policy on the rate of UTIs in acute care hospitals. BackgroundOctober 2008 commenced Medicare's nonpayment policy for the additional care required as a result of hospital-acquired conditions, including catheter-associated urinary tract infections (CAUTIs). CAUTIs are the most common form of hospital-acquired infections. MethodsRates of CAUTIs were analyzed by patient and hospital characteristics at the hospital level on a quarterly basis, yielding 20 observation points. October 2008 was used as the intervention point. A time series analysis was conducted using the 2005–2009 Nationwide Inpatient Sample datasets. A repeated measures Poisson regression growth curve model was used to analyze the rate of CAUTIs by hospital characteristics. ResultsThe annual rate of CAUTIs continues to rise; however the annual rate of change is starting to decline. The change in rate of CAUTIs was not significantly different before and after the policy's payment change. The results of the adjusted time series analysis show that various hospital characteristics were associated with a significant decline in rate of CAUTIs in quarters 16–20 (after the policy implementation) compared to the rate in time 1–15 (before the policy implementation), while other characteristics were associated with a significant increase in CAUTIs. ConclusionsMedicare's nonpayment policy was not associated with a reduction in hospitals’ CAUTI rates. The use of administrative data, improper coding of CAUTIs at the hospital level, and the short time period post-policy implementation were all limitations in this study.

Advance care planning discussions among residents of long term care and designated assisted living: experience from Calgary, Alberta

ObjectivesPatients, physicians and the healthcare system are faced with the challenge of determining, and respecting, the medical wishes of an aging population. Our study sought to describe who participates in...

Smoke-free or not: a pilot evaluation in selected Beijing Hospitals

BackgroundChina enacted a policy to ban smoking in hospitals. The Chinese Association for Tobacco Control (CATC) developed a program to help hospitals implement this policy. They conducted a program and an assessment in 3 Chinese cities (Beijing, Shanghai and Guangdong). A more in-depth evaluation was implemented with a sub-sample of hospitals in Beijing (N = 7) to provide an independent assessment. This independent assessment focused on evaluating policy development and an assessment of secondhand smoke (SHS) to determine compliance with the smoke-free policy initiative.MethodsPre- and post-survey data were collected at each of the selected hospitals with a total sample of 2835 physicians at pre-intervention and 2812 at post-intervention. Smoking rates pre- and post-policy implementation, change in knowledge, attitudes and practices among physicians, and compliance with policy were assessed. Measurements of airborne nicotine concentrations in selected locations in each hospital were taken: main hospital lobby; main outpatient center; emergency waiting room; and stairwell adjacent to a large inpatient ward. Hospital policies were collected, translated and rated for incorporated components necessary to implement a smoke-free policy.ResultsPhysicians’ smoking rates decreased and attitudes towards tobacco control improved significantly from pre-to post-intervention. Smoking was still reported in certain areas of the hospital with 96% of passive nicotine monitors as well as self-report indicating continued smoking. Nicotine levels ranged from <0.0056 to 3.94 μg/m3), with an overall mean of .667 μg/m3. Hospitals that established stronger policies seemed to have lower levels of nicotine, suggesting a relationship between policy development and compliance. This finding is interesting but just suggestive and requires further investigation to truly demonstrate if stronger policies improve compliance and produce better outcomes.ConclusionAs implementation strategies for smoke-free environments are improved and more resources are focused on hospitals, China is making progress toward achieving smoke-free hospitals. Using a model program could increase the prevalence of SHS policies across China. However, relying only on survey data may not provide an accurate assessment of this progress, and more extensive evaluation efforts are useful to understand how change can and does occur.

Influence of a Tobacco-Free Hospital Campus Policy on Smoking Status of Hospital Employees

To examine the influence of a tobacco-free hospital campus (TFHC) policy on employee smoking behavior. Questionnaires immediately prior to, 6 months after, and 1 year after implementation of a TFHC policy. University-affiliated hospital system. A cohort of smokers and recent quitters. Smoking status, quit attempts, influence of TFHC policy. Descriptive. From 2024 employees who responded to an initial online survey prior to implementation of a TFHC policy, 307 respondents reported either current smoking or quitting smoking within the past 6 months. Of these, 210 (68%) agreed to follow-up surveys at 6 and 12 months post-policy implementation. At each of the three times, between 15% and 18.5% of the cohort reported not smoking, with at least 48% of those not smoking reporting 6 to 12 months continuous abstinence. Sixty percent or more of those who reported quit attempts or not smoking indicated that the TFHC policy was influential in their efforts. A TFHC policy may lead to increased employee smoking quit attempts and successful cessation. Health care facilities should broaden smoking restrictions to include the entire workplace campus, not only to reduce exposure to environmental tobacco smoke, but also to increase tobacco cessation.

A province-wide school nutrition policy and food consumption in elementary school children in Prince Edward Island.

Although the majority of Canadian provinces have indicated that they have adopted new school nutrition policies, there have been few if any systematic evaluations of these policies. In Prince Edward Island, a nutrition policy for elementary schools was adopted province-wide in 2006. In the present study, we assessed the nutritional benefits of the new policy by examining changes in student food consumption prior to and one year following implementation of the policy. We surveyed fifth and sixth grade children from 11 elementary schools in Prince Edward Island in 2001/02 (pre-policy implementation) and fifth and sixth grade children from the same 11 schools in 2007 (post-policy implementation). Food consumption was assessed using a self-administered validated food frequency questionnaire. We applied multilevel logistic regression to compare pre-/post-policy implementation differences in the proportion of students meeting Canada's Food Guide recommendations for vegetables and fruit (VF) and milk and alternatives (MA) and in the proportion of students consuming < 3 servings of low nutrient dense foods (LNDF) daily. Relative to students in 2001/02, students surveyed in 2007 were 2.14 (95% CI 1.62-2.82) times more likely to report consuming less than three daily servings of LNDF and were more likely to meet recommendations for VF (OR 1.44, 95% CI 1.00-2.07) and MA (OR 1.27, 95% CI 0.98-1.64). The present study is the first in Canada to show favourable changes in student food consumption that parallel the introduction of a school nutrition policy.

A Province-wide School Nutrition Policy and Food Consumption in Elementary School Children in Prince Edward Island

Objective: Although the majority of Canadian provinces have indicated that they have adopted new school nutrition policies, there have been few if any systematic evaluations of these policies. In Prince Edward Island, a nutrition policy for elementary schools was adopted province-wide in 2006. In the present study, we assessed the nutritional benefits of the new policy by examining changes in student food consumption prior to and one year following implementation of the policy. Methods: We surveyed fifth and sixth grade children from 11 elementary schools in Prince Edward Island in 2001/02 (pre-policy implementation) and fifth and sixth grade children from the same 11 schools in 2007 (post-policy implementation). Food consumption was assessed using a self-administered validated food frequency questionnaire. We applied multilevel logistic regression to compare pre-/post-policy implementation differences in the proportion of students meeting Canada’s Food Guide recommendations for vegetables and fruit (VF) and milk and alternatives (MA) and in the proportion of students consuming Results: Relative to students in 2001/02, students surveyed in 2007 were 2.14 (95% CI 1.62-2.82) times more likely to report consuming less than three daily servings of LNDF and were more likely to meet recommendations for VF (OR 1.44, 95% CI 1.00-2.07) and MA (OR 1.27, 95% CI 0.98-1.64). Conclusion: The present study is the first in Canada to show favourable changes in student food consumption that parallel the introduction of a school nutrition policy. Key words: Nutrition; nutrition policy; nutrition surveys; dietary habits; school health; obesity

Anonymous examination marking at University of Cape Town: The quest for an `agonising-free zone'

In 2003 the University of Cape Town introduced an anonymous examination policy. This article reports on a study of the impact of the implementation of this policy on student performance. Comparisons of student results pre- and post policy implementation showed no evidence of negative or positive discrimination of students in the examination marking. Interviews with course conveners suggested however, that, irrespective of the policy, markers infer student identity from examinations and that these inferences can influence their assessment. The most commonly cited example was 'sympathetic marking', that is, assessors marking more generously if they infer a student to be educationally under-prepared. The article concludes that the implementation of this policy has had a limited impact on strengthening the validity of assessment results, but is likely to be retained given both staff and students' perceptions that the policy 'objectifies' the marking process.

Researching assessment as social practice: Implications for research methodology

Recent educational journals on both sides of the Atlantic have seen a resurgence of debate about the nature of educational research. As a contribution to these debates, this paper draws on theoretical and methodological ‘thinking tools’ of French sociologist Pierre Bourdieu. Specifically, the paper explores what Jenkins [Jenkins, R. (2002). Pierre Bourdieu. London: Routledge and Falmer] refers to as Bourdieu's “reflexive epistemological pluralism” and its implications for research into higher education, with a particular focus on assessment as social practice. This particular theoretical and methodological understanding is used to critically reflect on a study conducted in 2005 on the impact of a policy on anonymous examination marking which was implemented at the University of Cape Town in 2004. The study collected both quantitative data of student examination performance pre- and post-policy implementation, as well as interviews with course conveners. The paper argues that when viewed interdependently the data offers insight into some of the “principles of vision and division” [Bourdieu, P. (1996). The state nobility: Elite schools in the field of power. Cambridge: Polity Press] at work in assessors’ judgment-making process. The assessors’ deliberations expose ideological tensions between the dual challenges of equity and excellence in the context of a historically white liberal university under transformation.

A Written Policy Increases Compliance With Guidelines for Therapeutic Anticoagulation Prior to Elective Direct Current Cardioversion of Atrial Fibrillation

Therapeutic anticoagulation before elective direct current cardioversion (DCC) of atrial fibrillation reduces the risk of embolic stroke. Direct current cardioversion is performed by a variety of practitioners, and variable adherence to preprocedural anticoagulation guidelines is common. We assessed the impact of a written policy on guideline compliance. : Anticoagulation status and transesophageal echocardiogram (TEE) results were reviewed in 55 patients (32 men/23 women; ages 18-83 years) who underwent elective DCC during the 6-month period before a written anticoagulation policy was sent to physicians who perform, prepare, or refer patients for this procedure. The nurse assigned to each DCC was responsible for documenting anticoagulation status. In accordance with guidelines, therapeutic anticoagulation was defined as a normalized ratio range > or = 2.0 for at least 3 weeks or a negative TEE with a normalized ratio range > or = 2.0 or a partial thromboplastin time > 50 seconds at the time of DCC. Immediately after policy implementation, anticoagulation status and TEE results were reviewed in 53 patients (42 men/11 women; ages 21-84 years) and 1 year post-policy implementation. Before policy implementation, 14 of 52 patients (27%) had DCC performed without adequate anticoagulation or a negative TEE. Immediately postimplementation, only 2 of 50 patients (4%) had DCC performed without adequate anticoagulation or a negative TEE (P = .002). One year post-policy implementation, only 4 of 48 patients (8%) had DCC performed without adequate anticoagulation or a negative TEE (P = .03). Implementing a written policy greatly reduces the number of patients undergoing DCC without adequate anticoagulation or a negative TEE. The impact of this intervention was quickly demonstrable and persisted during follow-up. Supplementing published recommendations with guideline-driven policies may reduce variations in clinical practice and improve quality of care.

Outcomes of referrals over a six‐month period to a mental health gateway team

Mental health policy in recent years has prescribed the role, function and form for services in England. Evidence of their effectiveness post-policy implementation has been limited to date and minimal guidance has been available on how services should operate together as whole systems. This paper reports findings from a study of referrals and their outcomes in respect of specialist community mental health services following implementation of national policy and its interpretation and configuration at a local level. Findings highlight that gateway workers configured as a team operating between primary and secondary care can effectively shield community mental health teams from high numbers of referrals that they would deem inappropriate. The study also identified the triage role of this service as being crucial to the effectiveness of developing and maintaining care pathways and also in potentially supporting the mental health capability of primary care.

The impact of over‐the‐counter simvastatin on the number of statin prescriptions in the United Kingdom: a view from the General Practice Research Database

The United Kingdom (UK) government changed the prescription policy of statins, making low-dose simvastatin (10 mg) available as an over-the-counter (OTC) drug in August 2004. We assessed the impact of this policy change on statin prescribing. We examined all statin prescriptions in the General Practice Research Database (GPRD), a well-validated database of approximately 3.5 million patients, from the first quarter of 2001 to the second quarter of 2005. From 2001, the number of statin prescriptions written for GPRD patients was increasing by approximately 437 prescriptions per 100,000 people per quarter until the time of the policy change. Over the four quarters post-policy implementation, however, this trend changed abruptly (p < 0.0001) with a decrease of 281 prescriptions per 100,000 people per quarter. This decrease was not restricted to prescriptions of 10 mg statins but was also observed for statin prescriptions of >or=20 mg. Several other cardiovascular medications displayed a similar trend as that observed in the number of statin prescriptions. This trend was not observed among non-cardiovascular control medications. Our study suggests that the policy allowing the OTC sale of 10 mg simvastatin has had a significant impact on statin prescriptions by general practitioners. However, this new policy may also be leading to less aggressive statin therapy. An alternative explanation for the observed decrease in statin prescriptions may be related to the unknown factors responsible for the overall decrease observed with other cardiovascular prescription drugs.

A “smoke-free” hospital in Israel—a possible mission

Background. A revised antismoking law in Israel (August 2001) called for a complete ban of smoking in hospitals. An evaluation of a hospital process and short-term outcome of implementing such policy may guideline its sustainability. Methods. Two cross-sectional, random-sample surveys of employees 3 months before policy implementation, and 6–9 months post-implementation. The pre-implementation survey included 368 employees (90.4% response rate) and the post-implementation survey, 364 (92.8% response rate). Results. The ‘smoke-free’ policy significantly reduced smoking in the unauthorized areas. Before implementation, 63% of staff reported frequently observing smoking in the hospital, compared to 40% 6 months post-policy implementation ( P < 0.001). Significantly more smokers reported leaving their workplace to smoke (17% pre- vs. 62% post-implementation, P < 0.0001). Sixty-five percent of smokers, in both surveys, agreed that “a smoke-free policy is unfair to smokers”. Fewer nonsmokers subscribed to this belief: 42% pre- and 34% post-implementation. Smoker prevalence remained unchanged (19%). Conclusions. Implementation of a “smoke-free” policy is an effective way to reduce smoking in the hospital environment. More effort is required, however, to help staff quit smoking altogether.