Differences in the delivery of health education to patients with chronic disease by provider type, 2005-2009.

INTRODUCTION: 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. CONCLUSION: 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.

Frequency and Confidence of Healthcare Practitioners in Encountering and Addressing Nutrition-Related Issues.

OBJECTIVE: Identify the frequency of nutrition issues encountered by healthcare professionals and their confidence in addressing these issues. METHODS: A survey designed to assess the frequency and type of nutrition issues most often encountered in practice of a variety of healthcare professionals and the practitioners' confidence in addressing nutrition issues was developed and distributed to 5,729 graduates from an academic medical center. Descriptive statistics were calculated for all variables. Logistic regression models were used to find predictors of confidence. RESULTS: The final response rate was 17.2% (n=987). The most common nutrition-related problems encountered included obesity (43.8%), diabetes mellitus (43%), and cardiovascular disease (37.1%). Nutrition issues were encountered daily or weekly by 70.5% of healthcare providers, but only 24.8% felt "very confident" in addressing nutrition issues. Significant predictors of confidence included number of years working, more frequent nutrition-related encounters, and nutrition education in professional programs. CONCLUSION: Healthcare practitioners encounter nutrition issues frequently in practice and often do not have a high level of confidence in addressing these issues.