title: Differences in the delivery of health education to patients with chronic disease by provider type, 2005-2009.
abstract: BACKGROUND
  Health education provided to patients can reduce mortality and morbidity of chronic disease. Although some studies describe the provision of health education by physicians, few studies have examined how physicians, physician assistants, and nurse practitioners differ in the provision of health education. The objective of our study was to evaluate the rate of health education provision by physicians, physician assistants, and nurse practitioners/certified midwives.
  
  
  METHODS
  We analyzed 5 years of data (2005-2009) from the outpatient department subset of the National Hospital Ambulatory Medical Care Survey. We abstracted data on 136,432 adult patient visits for the following chronic conditions: asthma, chronic obstructive pulmonary disease (COPD), depression, diabetes, hyperlipidemia, hypertension, ischemic heart disease, and obesity.
  
  
  RESULTS
  Health education was not routinely provided to patients who had a chronic condition. The percentage of patients who received education 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). For all conditions assessed, rates of health education were higher among physician assistants and nurse practitioners than among physicians.
  
  
  CONCLUSIONS
  Physician assistants and nurse practitioners provided health education to patients with chronic illness more regularly than did physicians, although none of the 3 types of clinicians routinely provided health education. Possible explanations include training differences, differing roles within a clinic by provider type, or increased clinical demands on physicians. More research is needed to understand the causes of these differences and potential opportunities to increase the delivery of condition-specific education to patients.
authors.affiliation: University of Nebraska Medical Center, Physician Assistant Program, 984300 Nebraska Medical Center, Omaha, Nebraska 68198. E-mail: tamara.ritsema@unmc.edu.
authors.forename: Tamara S
authors.initials: TS
authors.lastname: Ritsema
authors.affiliation: The George Washington University, Washington, DC.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Bingenheimer
authors.affiliation: The University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Patty
authors.initials: P
authors.lastname: Scholting
authors.affiliation: The George Washington University, Washington, DC.
authors.forename: James F
authors.initials: JF
authors.lastname: Cawley
mesh_terms: D002908:Chronic Disease; D006801:Humans; D009722:Nurse Practitioners; D010353:Patient Education as Topic; D010823:Physician Assistants; D010820:Physicians; D012648:Self Care / Q000379:methods; D014481:United States