APN-physician collaboration in caring for women with high-risk pregnancies.
OBJECTIVE
To examine: (a) frequency and focus of APN-physician collaborations in a clinical trial in which half of physician prenatal care for women with high-risk pregnancies was substituted with APN prenatal care delivered in women's homes; and (b) characteristics of women requiring greater numbers of collaborations.


METHODS
Descriptive study with secondary analysis of data from 83 of the original trial's 85 intervention participants followed by APNs prenatally through 8 weeks postpartum. APN practices, recorded in logs, included APN interactions with the women and the physician, and type of APN contact (e.g., home visit, telephone call). Each APN-physician collaboration was coded for type, timing, and focus.


RESULTS
Total number of APN-physician collaboration contacts was 351, with a mean of 4.5 and a range of 1 to 16 per woman. Focus of collaborations was: status updates (59%), new physical findings (21%), change in treatment (8%), patient concerns (7%) and medication adjustment (5%). No significant differences in numbers of collaborations were found according to age, primary diagnosis, marital status, type of health insurance, race, or income. Women with high school education received more collaborations than did those not completing high school or those with some postsecondary education. Prenatally, women with a first pregnancy required more collaborations than did multipara participants.


CONCLUSIONS
Most APN-physician collaborative contacts were focused on monitoring women's physical and emotional status and discussing new physical findings. These collaborations were important in the original trial's successful pregnancy and infant outcomes and savings in health care dollars.
Brooten
Dorothy
D
Florida International University, School of Nursing, 3000 NE 151st St., AC II Rm 230, North Miami, FL 33181, USA. Brooten@fiu.edu
Youngblut
JoAnne
J
Blais
Kathleen
K
Donahue
Deborah
D
Cruz
Ivette
I
Lightbourne
Michelle
M
D000328:Adult; D003142:Communication; D003299:Cooperative Behavior; D004522:Educational Status; D004645:Empathy; D005260:Female; D006801:Humans; D016294:Models, Nursing; D009720:Nurse Clinicians / Q000458:organization & administration / Q000523:psychology*; D024802:Nurse's Role; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D017063:Outcome Assessment, Health Care; D010298:Parity; D010808:Physical Examination / Q000451:nursing; D019555:Physician-Nurse Relations; D011181:Postnatal Care / Q000458:organization & administration; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000517:prevention & control*; D018566:Pregnancy, High-Risk; D011295:Prenatal Care / Q000458:organization & administration; D016032:Randomized Controlled Trials as Topic