Table 4 Studies of Advanced Practices Registered Nurses and Physician Assistants (APRN/PA) and diet, physical activity, and smoking cessation recommendations
Study | Sample size | Outcome measure | Setting | Findings for diet | Findings for physical activity | Findings for smoking cessation |
|---|---|---|---|---|---|---|
Tompkins et al., [33] | Total providers: 398 | Self-report of NPs | Survey of NPs at Pacific Northwest Annual National Conference | NA | Physical activity counseling of appropriate patient in past week: | NA |
NPs: 398 | ||||||
Cross sectional survey | 25% of NPs reported counseling 50% of appropriate patients | |||||
37.75% of NPs reported counseling 75% of appropriate patients | ||||||
14.8% of NPs reported counseling 100% of appropriate patients | ||||||
Selected factors that facilitate physical activity counseling with patients: | ||||||
69.2% of NPs reported length of patient visit | ||||||
55.4% of NPs reported part of preventative health visit | ||||||
P-value not reported | ||||||
Patton et al., [25] | Total providers: 1802 | Self-report of MDs and NPs | Surveys of health professionals in North Carolina | NA | NA | NPs report that they assess: |
Patient’s past tobacco use: 95.1% | ||||||
Family physicians: 273 | ||||||
Patient’s present tobacco use: 97.9% | ||||||
NPs: 294 | ||||||
Dentists: 584 | Â | Cross sectional Survey | Type and amount of tobacco: 92.3% | |||
Hygienists: 651 | ||||||
P-value not reported | ||||||
Family MDs report that they assess: | ||||||
Patient’s past tobacco use: 98.5% | ||||||
Patient’s present tobacco use: 100% | ||||||
Type and amount of tobacco: 95.5% | ||||||
P-value not reported | ||||||
Adequately trained for smoking cessation | ||||||
NPs: 71.4% | ||||||
Family MD: 93.5% | ||||||
P-value not reported | ||||||
Physicians are significantly more likely to feel adequately trained to provide tobacco cessation compared to NPs | ||||||
OR = 5.3 (3.2 - 8.6) | ||||||
P-value<.0001 | ||||||
All measures unadjusted | ||||||
Price et al., [35] | Total providers: 194 | Self-report of CNMs | Survey of CNMs in Ohio | NA | NA | CNMs reported that they always/usually: |
CNMs: 194 | Cross sectional survey | Document cigarette smoking use status at each visit: 73% | ||||
All patients pregnant women | Assess whether the patient is willing to make a quit attempt within the next 30Â days: 66% | |||||
Use counseling to help patients willing to make a quit attempt: 48% | ||||||
P-value not reported for all measures | ||||||
All measures unadjusted | ||||||
Running et al., [36] | Total patients: 400 | Chart review | Chart review of urgent care setting in HMO in the Southwest | NA | NA | Smoking cessation addressed among non-pharmacological interventions for sinusitis: |
NP patients: 200 | ||||||
Physician patients: 200 | ||||||
Retrospective cohort | NPs: 49% | |||||
MDs: 31% | ||||||
Number of times smoking cessation is addressed for subjects in all categories | ||||||
NPs: .97 | ||||||
MDs: 1.95 | ||||||
P-value=.309 | ||||||
Unadjusted | ||||||
Hopkins et al., [26] | Total Patients: 1339 | Chart review | Chart review in private practice and primary care health centers in NY City | Receipt of assessment and counseling on nutrition and diet: | Receipt of assessment and counseling on physical activity: | Receipt of assessment and counseling on tobacco use: |
Primary health care center (PHCC) NP patients: 755 | ||||||
PHCC NPs: 41.4% | PHCC NPs: 15.8% | PHCC NPs: 79.2% | ||||
PHCC MDs: 14.7% | PHCC MDs: 2.5% | PHCC MDs: 87.8% | ||||
MD patients: 441 | ||||||
Retrospective cohort | P-value=0.000 | P-value=0.000 | P-value=0.000 | |||
Private practice NP patients: 143 | ||||||
Unadjusted | Unadjusted | Unadjusted | ||||
Lin et al., [27] | Total hospital outpatient department visits: 90,476 | Chart review | National survey of hospital ambulatory settings (NAMCS) | Received diet counseling at an OPD visit with a NP compared to one without a NP | Received physical activity counseling at an OPD visit with a NP compared to one without a NP | Received tobacco use counseling at an OPD visit with a NP compared to one without a NP |
Visits with NP: 6,062 | Â | Cross sectional survey | 32.6% vs. 22.9% | 14.5% vs. 9.3% | 6.7% vs. 4.3% | |
Visits without NP: 84,416 | Â | Odds ratio adjusted for patient age, sex, clinic type, metropolitan status, geographic region of hospital, and number of providers seen. | Non-illness patients: 1.7 OR (95% CI OR: 1.2-2.5) | Non-illness patients: 1.8 OR (95% CI OR: 1.2-2.8) | Non-illness patients: 1.7 OR (95% CI OR: 1.2-2.5) | |
P- value = 0.004 | P- value = 0.007 | P- value = 0.004 | ||||
OPD visits for patients with chronic problems with a NP compared to one without a NP: | OPD visits for patients with chronic problems with a NP compared to one without a NP: | OPD visits for patients with chronic problems with a NP compared to one without a NP: | ||||
32.3% vs. 17.1% | 20.2% vs. 8.9% | 4.7% vs.2.9% | ||||
2.5 OR (95% CI OR: 1.6-3.8) | 2.8 OR (95% CI OR: 1.6-5.1) | 1.8 OR (95% CI OR: 1.1-3.0) | ||||
P-value = 0.001 | P-value = 0.007 | P-value = 0.01 | ||||
Moody et al., [37] | Total Providers: 44 | Self-report of | Survey of NPs in Tennessee | Provider report nutrition counseling: | Provider report physical activity counseling: | Provider report smoking cessation counseling: |
NPs: 44 | NPs | Cross sectional survey | NPs: 19% | NPs: 12% | NPs: 7% | |
Total patients: 680 | MDs: 15% | MDs: 7% | MDs: 2.5% | |||
P-value not reported | P-value not reported | P-value not reported | ||||
Unadjusted | Unadjusted | Unadjusted | ||||
Gebauer et al., [38] | Total patients: 178 | Self-report of patients and Salivary Cotinine Sample | Follow up survey at outpatient obstetric clinic - state not specified | NA | NA | Smoking rate/day at follow-up: Mean (SD) |
Control patients: 94 | Control: 13.7 (14.1) | |||||
Intervention patients: 84 | Intervention | Intervention: 7.8 (7.3) | ||||
All patients pregnant women who report smoking and intervention includes being seen by an advance practice NP | P =.008 | |||||
Unadjusted | ||||||
Smoked any amount in past 7Â days: | ||||||
Control Baseline: 94 participants | ||||||
Control Follow up: 94 participants | ||||||
Intervention Baseline: 83 participants | ||||||
Intervention Follow up: 70 participants | ||||||
Difference between groups =15.5% P-value<0.001 | ||||||
Unadjusted | ||||||
Murphy, [31] | Total providers: 346 | Self-report of CNMs | National survey of CNMs | Nutritional counseling of gynecologic patients | Physical activity counseling of gynecologic patients | Smoking cessation counseling of gynecologic patients |
CNMs: 346 | Cross sectional survey | 52% of CNMs report counseling 81-100% of their patients | 46% of CNMs report counseling 81-100% of their patients | 72% of CNMs report counseling 81-100% of their patients | ||
P-value not reported | P-value not reported | P-value not reported | ||||
Unadjusted | Unadjusted | Unadjusted | ||||
Zahnd et al., [32] | Total patients: 1217 | Self-report of patients | Survey of patients from Four Kaiser Permanente Medical Centers in San Francisco Bay Area | NA | NA | Patients report discussing smoking cessation: |
NP patients: 269 | NP Patients: 64% | |||||
Physician patients: 948 | MD Patients: 50% | |||||
P-value<0.001 | ||||||
Total providers: 52 | Intervention | Unadjusted | ||||
Physicians: 40 | Independent predictors of counseling about smoking: | |||||
NPs: 12 | NP vs. Physician: OR 1.7 | |||||
P-value=.0006 | ||||||
Adjusted for differences in patient characteristics |