[Temporal evolution of tobacco consumption among health care workers in a Catalonian hospital, Spain]. / Evolución del consumo de tabaco en trabajadores de un hospital de Cataluña.

BACKGROUND: In terms of tobacco consumption, health workers have been considered as reference group, however smoking prevalence in this group is higher than in general population. This study aimed to estimate the prevalence of tobacco consumption among workers of a health institution in Catalonia during a period of 10 years (2001-2011), and to describe their characteristics. METHODS: The questionnaire on tobacco consumption prevalence was validated, and was administered in 2001, 2004, 2008 and 2011. A random sampling was carried out in two acute care institutions. The characteristics of the study sample and the differences between smokers were analyzed using the chi-square test for linear trend. A logistic regression model was performed including all the surveys. RESULTS: The smoking prevalence among health care workers for 2001, 2004, 2008 and 2011, was 30.00%, 34.42%, 36.21% and 29.42%, respectively. Women had the highest consumption prevalence (33,40%). Tobacco smoking decreased in medical staff, from 25.97% in 2001, to 18.88% in 2011 (p=0.005), and in nurses from 35,15% in 2001 to 25.61% in 2011 (p=0.007), but not among the administrative staff. CONCLUSION: Overall and for the first time, smoking prevalence in health workers begins to decrease. However, it does not decrease in the same way among all types of healthcare workers and the prevalence remains high when compared with the population prevalence. This consumption reduction coincides with the measures introduced by the program after the legislative changes.

Do smoke-free environment policies reduce smoking on hospital grounds? Evaluation of a smoke-free health service policy at two Sydney hospitals.

OBJECTIVE: To evaluate the compliance of hospital staff, inpatients and visitors with Sydney South West Area Health Service's Smoke-free Environment Policy. METHODS: Six sites were observed at two Sydney hospitals 2 weeks before implementation of the policy and at 2 weeks, 6 months, 12 months, 18 months and 2 years after implementation. RESULTS: There was an overall significant 36% (P≤0.05) reduction in observed smoking incidents on hospital grounds 2 years after implementation. Two years after implementation, observed smoking incidents reduced by 44% (P≤0.05) in staff, 37% (P≤0.05) in visitors and remained unchanged among inpatients. CONCLUSIONS AND IMPLICATIONS: The Smoke-free Environment Policy was effective in reducing visitors and staff observed smoking on hospital grounds, but had little effect on inpatients' smoking. Identifying strategies to effectively manage nicotine addiction and promote cessation amongst hospital inpatients remains a key priority.

One hospital's successful 20-year experience with physician assistants in graduate medical education.

The downsizing of residencies and the migration of residents to outpatient settings create an increasing need to protect residents' educational experiences and to maintain standards of hospital care. Some hospitals have solved this dilemma by using mid-level practitioners (MLPs), including physician assistants (PAs), to augment the diminished staffs of residents in their surgical residencies. The authors describe how their hospital has done so. Their surgical PA program, begun in 1979, seeks to meet the hospital's expectations for in-house coverage of surgical patients, to protect the educational integrity of the physician residency program in surgery, to allow protected time for residents' conferences and clinics, and to prepare residents for future practice in multidisciplinary teams. The PA and residents' services are partly separated, which reduces the potential for resident-PA conflict. Responsibilities for both residents and PAs are stratified (junior vs senior status). Both services are teaching services, which helps motivate PAs to be committed to the service and helps foster the equality between residents and PAs that the program strives for. The residents have come to value the PAs, and the program's goals have been achieved, including protecting time for residents' education and maintaining humane on-call schedules for residents. The authors discuss job satisfaction, turnover, and the hard financial realities of paying for PAs' salaries, benefits, and educational programs, as well as the loss of Medicare DME and IME reimbursements when a PA replaces a resident. Ways some of these costs can be recovered are outlined. The authors conclude with recommendations on how to deal with six key issues of PA or other MLP programs: need for institutional commitment; importance of local circumstances; emphasis on partnership, not competition, between PAs and residents; value of an education component; need to build a cohesive program, and the importance of effective PA leadership.