In smoking cessation, the most effective intervention continues to be a physician s recommendation for the patient to quit. However, quit rates for smoking are also dependent on the appropriate use of medical therapies and group support programs.442,471 In dia- betes care, patient education has the potential to be as effective as or more effective than medical therapies.472 The management of hypertension, heart failure, dyslipidemia, type 2 diabetes mellitus, weight loss, and physical activity is enhanced by ongoing health education and support in addi- tion to physician office visits. Factors that complicate effective patient education include low literacy, adverse sociodemographic factors (eg, poverty, social isolation, and emotional disorders such as depression), cultural beliefs and language barriers, environmental factors, advanced age, and the presence of complex comorbidities. These factors and others play an important role in the adoption of healthy lifestyles and adherence to recommended medical therapies. In addition, how to best provide cost- effective educational strategies remains a challenge in today s healthcare environment.473 The lack of payment for these activities remains an important barrier. Clinic-based educa- tion generally consists of the following: 1. Individual counseling. This educational format com- monly is used in the context of a routine clinic visit. It tends to be directive and didactic, generally not inter- active or behaviorally oriented, relatively brief, and sometimes supported with written materials. Follow-up to ascertain effectiveness is not commonly practiced. 2. Group education. Group care or shared office visits have been tested in multispecialty group practices. They offer the benefit of providing education to larger num- bers of patients with similar diagnoses (eg, type 2 diabetes mellitus), combined with an individualized physician visit. They tend to be behaviorally oriented with planned follow-up for effectiveness and outcomes. 3. Self-monitoring. Self-monitoring skills enhance patient education and behavior change. 