NPs, PAs offer more advice on managing chronic conditions than physicians

But rates are low for all providers
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Physician assistants (PAs) and nurse practitioners (NPs) are more likely than physicians to advise patients who have chronic illnesses on how to live healthier lives, according to a new study published in Preventing Chronic Disease.

Researchers, led by Tamara S. Ritsema of the University of Nebraska Medical Center in Omaha, analyzed four years of data on more than 130,000 patients' office visits for eight chronic conditions: depression, obesity, diabetes, ischemic heart disease, hypertension, asthma, chronic obstructive pulmonary disease (COPD) and hyperlipidemia, according to the study.

Ritsema and her team investigated provision of education on subjects such as diet, stress management, exercise, weight loss and tobacco use by provider type. Although education provision was low across the board for all provider types, PAs and NPs informed patients at a higher rate than physicians across all conditions assessed, the study states.

The percentage of patients given information varied widely by condition, according to the study. For example, NPs informed 13 percent of patients with COPD or asthma on smoking cessation, and PAs gave 42.2 percent of patients with obesity or diabetes tips on exercise. In addition, the study found: 

  • NPs were more likely to give patients advice on diet or nutrition than PAs or physicians

  • PAs and NPs were both more likely to provide advice on exercise or weight loss than physicians

  • PAs were more likely to advise patients on tobacco use or exposure for COPD/asthma patients than either NPs or physicians

The reasons for these disparities are unclear, Ritsema and her team wrote, but possible explanations include greater clinical demands on physicians, differences in training and different roles within individual clinics. To bridge these gaps, "[p]olicymakers should consider increasing incentives for providers to deliver chronic condition–specific health education," they wrote.

In light of the physician shortage, many in the healthcare industry endorse legislation to increase the scope of practice for NPs and PAs. For example, a 2013 study found the greatest growth in NPs as primary care providers occurred in states that allow NPs to prescribe independently, FierceHealthcare previously reported.

To learn more:
- here's the study

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