CDC Study: Nurses, Physician Assistants More Likely to Provide Education in Chronic Disease Management than Doctors

Jun 3, 2014, 9:00 AM

Proper patient management of chronic diseases is increasingly important to the nation’s health care system, as the Baby Boom generation reaches the stage of life where such conditions are common. From diabetes, arthritis, and asthma to obesity, hypertension, and depression, the health care system is looking to train patients to take steps mapped out for them in discussions with their health care providers. A new study from the Centers for Disease Control and Prevention (CDC), however, finds that a minority of patients with chronic conditions receive education in managing their problems, and that some practitioners—nurses and physician assistants (PAs), in particular—are considerably more likely to provide such education than others.

“Disease self-management is an essential component of care for patients with most chronic conditions,” writes a team of researchers led by Tamara S. Ritsema, MPH, MMSc, PA-C. “Patients cannot perform daily self-management tasks if they have poor understanding of the disease process, medications used, or the practical tasks they need to accomplish to care for themselves. Health education is, therefore, a vital preventive element in the patient visit.”

The researchers examined five years of CDC data, accounting for more than 136,000 patients who had been diagnosed with asthma, chronic obstructive pulmonary disease (COPD), depression, diabetes, hyperlipidemia, hypertension, ischemic heart disease, or obesity. The records indicated whether the patients’ doctors, nurse practitioners (NPs), or PAs had provided education to the patients in the self-management of their conditions during each visit. 

The researchers found that, “Health education was not routinely provided to patients with chronic conditions.” Across each of the studied conditions, fewer than 50 percent of patients received education in any given visit.

For some conditions, the likelihood that patients received education increased markedly if their visit was with an NP or a PA. For example, patients who needed education in stress management were nearly twice as likely to receive it if they visited an NP (41.1 percent) than a doctor (20.7 percent). Patients needing education in exercise were much more likely to get it from a PA (42.2 percent) than a doctor (17.6 percent) or an NP (26.9 percent).

The researchers hypothesize that the education gap could be related to providers’ training. “One potential explanation,” they write, “is that training programs for physician assistants and nurse practitioners may emphasize the provision of health education to patients more than training programs for physicians.” They also suggest that the differences could be the product of physicians delegating health education to other members of their practices in follow-up visits.

Read the study and an article about it on

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.