Attributes and Disparities of Patient Health Education in Outpatient Care

Objective: Patients’ health education is increasingly important in patient-centered care, which is a critical way for physicians and patients to share information and feedback regarding health status and to make decisions about the needs outside of the physicians’ offices. I have identified the attributes of education in outpatient care and investigated the disparities by race and region.  

Methods: I utilized the 2010 National Ambulatory Medical Care Survey, which collected detailed information on health education ordered or provided to patients at each visit (e.g. asthma, diet/nutrition, exercise, injury prevention, stress management). The sample population was 27,061 patient observations from 1,241 physicians. The outcome variables were binary variable indicating at least one health education per visit, and the number of health education per visit. Independent variables included patient socio-demographics, chronic disease, and reason for physician visit; physician specialty, practice type, work in the evenings and weekends, and time spent with patients; and neighborhood median income and binary variables indicating four regions. I employed a multi-level mixed effect logistic model and negative binomial model for binary and count outcome, respectively. Estimations were conducted for total sample population and by race (non-Hispanic White [NHW] versus all others).

Results: Among all patients (mean age 45.8, 58.4% women, 71.2% NHW), 44.3% received at least one education per visit (average 1.53). For patient attributes, chronic disease was strongly associated with health education (odds ratio[OR]=1.54;P<0.01). Patients received more education when visiting a physician for preventive care (OR=1.69;P<0.01), routine check-ups for chronic diseases (OR=1.28;P=0.01), and post-surgery care (OR=1.31;P=0.04) (reference=new problems). For physician characteristics, surgical care (OR=0.67;P=0.01; reference=primary care) and HMO (OR=1.46;P=0.03; reference=private solo) were significantly associated with health education. Patients who spent 16–20 and ≥21 minutes with physicians received more education (P<0.05; reference ≤10 minutes). Patients in the Midwest, South, and West received less education (P<0.04; reference=Northeast). Sub-sample analysis by race indicated that all other races received less health education when their neighborhood median income was lower, and time spent with a physician had no influence among them while it was important among NHW. Estimation results for number of health education are similar with those with a binary outcome.

Conclusions: Health education could improve patients’ satisfaction and reduce unnecessary healthcare utilization by enhancing their comprehension and compliance. Understanding the attributes and disparities of health education is a crucial first step for medical practitioners and policymakers in designing health education and effective policies to improve patients’ health outcomes.