Date of Award


Document Type

Open Access Dissertation


Health Services and Policy Management


Norman J. Arnold School of Public Health

First Advisor

Zaina Qureshi


The onset of chronic disease is occurring earlier and more often in the lives of adult citizens of the United States. The literature has effectively demonstrated the efficacy that physician provision of health education services offers their patients and the positive effects it has for lowering risk factors for chronic disease. The literature has described the complexities physicians encounter in providing these services. The literature is not as plentiful in defining and describing the characteristics of physician practice that are associated with increased health education provision.

This study is an analysis of the factors that are associated with provision of health education by primary care physicians in their offices. For this study, three years of the National Ambulatory Care Medical Care Survey, (NAMCS) are used for analysis. Selected factors germane to physician practice are analyzed for their effects on three risk factors for chronic disease; tobacco use, lack of exercise and obesity.

The study findings show that use of electronic health record systems are associated with increased odds of providing health education services over non automated physician practices. Physicians of private group practices offer health education services less often than physicians in federally qualified health centers. Use of e mail, telephone conferences, and whether the physician received Allopathic or osteopathic training was not associated with provision of health education.

The study is relevant because of the need for a re-engineering of the financial and structural systems of physician practice that pre-empt offering health education in physician practice. Factors identified in this study, should be important considerations in the design of a new physician payment system that will incentivize physicians to include evidenced based health education as essential component of primary care delivery.