Self-efficacy, barriers, and opportunities: Examining the delivery of asthma education among U.S. primary care physician assistants
The delivery of asthma education among primary care physician assistants (PAs) has not been well documented in the literature. Although researchers have mentioned PAs in previous studies, the findings were not specific to the profession. This study had a quantitative cross-sectional research design with a convenience sample representative of primary care PAs from across the United States (N = 140). The purpose of the study was to determine what PA practice characteristics (primary care discipline, clinic location, time spent with patient, and years of work experience) were predictive for the delivery of asthma education delivery. The study also sought to determine if clinical experience (years of work experience and number of asthma patients seen weekly) was predictive of asthma education self-efficacy. The survey deployed in this study was a modified version of the National Ambulatory Medical Care Survey 2012 National Asthma Survey. Survey modifications included adding questions to focus on Component 2 (asthma education) of the National Asthma Education and Prevention Program EPR-3 guidelines and removing questions on asthma treatment and monitoring. The modified 2012 NAS was an 11-item survey to collect data on clinical demographics, clinical experience, measured asthma education resources, components of asthma education delivered, barriers to asthma education, asthma education self-efficacy, and perceived patient knowledge. The participants also completed a personal demographics survey. Multiple regression was conducted to determine the relationship between PA practice characteristics and asthma education and the relationship between clinical experience and asthma education self-efficacy. Further analyses included a binomial logistic regression to examine the relationship between asthma education and barriers, chi-square goodness of fit to examine the relationship between components of asthma education, and Spearman’s Rho to examine the relationship between perceived patient knowledge and asthma education. Statistical analysis was significant for the relationship between time spent with patient and total asthma education delivered (ß = .19, p = .03), indicating that more time spent with patient increased the delivery of asthma education. Based on the negative regression coefficient, male gender (ß = -.26, p < .01) was associated with higher levels of asthma education. Chi-square goodness of fit was also statistically significant for symptom recognition education (χ2(1) = 124.46, p < .001), risk-factor avoidance education (χ2(1) = 132.11, p < .001), home and work environment (χ2(1) = 37.03, p < .001), and observation of inhaler technique (χ2(1) = 9.26, p = .002), indicating a difference between the components of asthma education delivered by primary care PAs. Asthma action plans was the only asthma education component not statistically significant (χ2(1) = 0.46, p = .499). The statistical tests examining the relationships between clinical experience and asthma education self-efficacy, asthma education and barriers, and perceived patient knowledge and asthma education had no statistically significant results. The results of this study indicate that time is a primary barrier to the delivery of asthma education among PAs. Additionally, while the results do not indicate that PAs perform asthma education at significant lower rates than other PCCs, overall self-efficacy and rates of delivery need improvement.