Affordability considerations in certificate-of-need hospital capital expenditure review determinations.

Beginning in 1984, public affordability became a central standard along with public need in the review of hospital proposals for capital development in Rhode Island's certificate-of-need (CON) program.

Smoking rates among Rhode Island physicians: achieving a smoke-free society.

Over a 25-year period, regular surveys of physicians licensed in Rhode Island have recorded their smoking behavior. The six surveys show a decrease in the rate of cigarette smoking from 33% in 1963 to 4.6% in 1988. In the most recent survey, 65% of respondents reported never having smoked, and 87% of those who had ever smoked reported having quit. However, the statistic for the maximum number of cigarettes smoked regularly was higher for current smokers than for former smokers. Among physicians in the 1988 survey, most former smokers (85%) reported using only unassisted personal effort in quitting, whereas nearly half (48%) of current smokers tried methods involving assistance, such as self-help programs, group programs, or nicotine gum. Among former smokers who quit after 1983, the percentage trying assisted methods (34%) was closer to the percentage among current smokers. Apparently, remaining smokers include many heavy smokers who require more potent interventions in order to quit. Physicians in Rhode Island have almost become a smoke-free group. Their experience, coupled with their involvement in smoking prevention and cessation for their patients, can lead the rest of society on its path to becoming smoke-free.

Framework for the Rhode Island response to the injury problem.

Injuries are the fourth leading cause of death in Rhode Island as well as the US and are responsible for the greatest amount of premature death. Recent years have brought more national attention to the role of public health in injury prevention. The Rhode Island Department of Health has been involved in a variety of injury control research, programs and legislation. In 1989, the Injury Prevention Program was funded through a grant from the Centers for Disease Control to coordinate and implement injury control programs in the Department. Injury prevention priorities are set on the basis of mortality and morbidity data. An analysis of Rhode Island death certificate data from 1979 to 1988 reveals that motor vehicle crashes, suicides, falls, and homicides are the leading causes of injury deaths. Age patterns vary for each cause, but males predominate in all categories of injury deaths. Activities to reduce injuries are underway or planned. Physicians will play key roles in this effort.

Physician reporting of adverse drug reactions. Results of the Rhode Island Adverse Drug Reaction Reporting Project.

The Food and Drug Administration, Rockville, Md, contracted with the Rhode Island Department of Health, Providence, to conduct a project to increase reporting of suspected adverse drug reactions through physician education. Voluntary reporting, an important part of postmarketing surveillance that signals potential problems with marketed drugs, historically has been underused by physicians. After 2 years, there was a more than 17-fold increase in reports submitted directly from Rhode Island compared with the yearly average before initiation of the project. Increases in the total numbers of reports were paralleled by significant increases in the numbers of reports of severe reactions. Similar increases were not experienced nationally. Physicians in Rhode Island were surveyed before and 2 years after interventions began to determine changes in knowledge and attitudes about reporting of adverse drug reactions. Significant gains in knowledge and positive attitudes toward the reporting system occurred. We conclude that physicians can be stimulated to increase their reporting of suspected reactions, thereby improving the viability of the federal reporting system.

The future of public health: a survey of the states.

A survey of state health agencies was conducted to determine agreement and disagreement of state health officers with the recommendations contained in The Future of Public Health issued by the Institute of Medicine in 1988. The survey also measured the extent to which the IOM recommendations were judged currently in place or in the process of being implemented in the states. The survey showed almost unanimous consensus among the nation's state health officers for the vast majority of the recommendations. There was less consensus concerning the appropriateness of locating substance abuse, Medicaid, mental health, and regulation of health professions within state departments of health. However, a significant proportion of health officers favored a health agency location for these responsibilities (72%, 52%, 48%, and 38% respectively).