Study: PAs, NPs Do Better Job of Health Education Than Docs

Megan Brooks

March 07, 2014

Nurses and physician assistants (PAs) are more likely than physicians to offer tips on healthy living to patients with chronic illnesses during office visits, a new study shows, although none of the 3 providers do it regularly.

Health education provided to patients with asthma, diabetes, and other chronic illnesses can help them live a healthier life, but who provides this information during office visits, and how often? Few studies have looked at this issue.

Tamara S. Ritsema, MPH, MMSc, PA-C, from the University of Nebraska Medical Center in Omaha, and colleagues evaluated the rate of health education provision by physicians, PAs, and nurse practitioners (NPs).

The researchers used data from the National Hospital Ambulatory Medical Care Survey spanning 2005 to 2009 on 136,432 adult patient office visits for 9 chronic conditions: asthma, chronic obstructive pulmonary disease (COPD), depression, diabetes, hyperlipidemia, hypertension, ischemic heart disease, and obesity.

They analyzed the provision of education (by provider type) on asthma, diet/nutrition, exercise, stress management, tobacco use and exposure, and weight loss.

The study was published online March 6 in Preventing Chronic Disease, a publication of the Centers for Disease Control and Prevention.

The researchers report that health education was not routinely provided to patients with chronic conditions. In fact, they say rates of health education provision "in general are low."

"The percentage of visits in which patients received health education did not reach 50% for any combination of health education and provider type," the investigators report.

The percentage of patients who did receive health advice on their chronic condition ranged from 13.0% (patients with COPD or asthma who were provided education on smoking cessation by nurse practitioners) to 42.2% (patients with diabetes or obesity who were provided education on exercise by physician assistants).

In general, PAs and NPs offered health education specific to the patient's chronic condition more often than did physicians. NPs also were more apt to counsel patients on diet or nutrition (odds ratio [OR], 1.60) and stress management (OR, 2.68) than either physicians or PAs.

PAs were more likely to provide counseling on tobacco use and exposure (OR, 3.62) for patients with COPD and asthma than were physicians or NPs.

PAs and NPs also were more apt to counsel on exercise (OR, 3.42 and 1.72, respectively) and losing weight (OR, 2.50 and 1.96) than were physicians.

Ritsema and colleagues say it is unclear why PAs and NPs provide more health education than physicians, and their study cannot address this. Possible explanations include training differences, differing roles within a clinic by provider type, or increased clinical demands on physicians.

If physicians do not have the time, interest, or skill in providing health education to their patients, "our study may argue for increasing the mix of providers in outpatient clinics," the investigators suggest.

They say more research is needed to determine what is behind differences they uncovered and identify potential opportunities to increase the delivery of health education to patients.

They suggest policymakers "consider increasing incentives for providers to deliver chronic condition–specific health education."

Prev Chronic Dis. 2014;11:130175. Full text

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