Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #114367

Bret Simon, PhD, Health Care Professions, Southern Illinois University, Applied Sciences and Arts, MC-6604, Carbondale, IL 62901-6604, 618-536-6682, bsimon@siu.edu and Fred R. Isberner, PhD, Associate Dean, College of Applied Sciences and Arts, Southern Illinois University Carbondale, Mailcode 6604, Carbondale, IL 62901-6604.

The number of physician assistants practicing in the United States has been growing considerably in recent years. The number of physician assistant programs has more than doubled in the past decade, and each year about 3,400 new physician assistants enter the health care workforce. Ultimately, a physician assistant's responsibilities within a medical practice will depend upon the needs and limits of the supervising physician, but research has reported that physician assistants are frequently expected to perform patient education and counseling. In this study, we investigated differences in patient education and counseling for ambulatory visits to physicians and physician assistants. Eight years of data from the National Ambulatory Medical Care Survey (NAMCS) were used in the analysis (1995 through 2002). SAS and SUDAAN software were used to compare rates of counseling and education for the nine types of patient education and counseling included in the survey. Chi-square analyses were used to determine whether significant differences existed in the numbers of visits that provided or ordered education, therapy, or counseling by either physicians-only or physician assistants alone or in combination with a physician. The total estimated number of patient visits that included or ordered patient education, therapy, or counseling was 2.34 billion. This represents 36.64% of all visits within the eight year data period. Statistically significant differences in rates (p<.05) for physicians or physician assistants alone or in combination with physicians were obtained for asthma education, growth/development, mental health/stress management, and psychotherapy. Nonsignificant results were obtained for diet and nutrition, exercise, physiotherapy, tobacco use/exposure, and weight reduction. In all cases, the differences favored physicians. That is, physician visits were more likely to provide or order counseling, education, or therapy than visits that included a physician assistant. This finding challenges the expected result: that visits that included a physician assistant would be more likely to include patient education or counseling. Of the visits that included a physician assistant, 71% also included a physician. Visits to physician assistants-only represented a minority of total physician assistant visits—just 29%. Most physician assistants report that the proportion of their visits that require the direct involvement of a physician is significantly lower than this. These data, therefore, may represent a special subset of physician assistant practice, and the findings may not be generalizable to physician assistant practice in all ambulatory settings.

Learning Objectives:

• Describe the relative rate of ambulatory patient visits that include or order some form of education, counseling, or therapy.
• Identify the types of patient education for which there is a significant difference between physician and physician assistant patient visits.

Keywords: Patient Education, Ambulatory Care

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.