title: APN-physician collaboration in caring for women with high-risk pregnancies.
abstract: 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.
authors.affiliation: Florida International University, School of Nursing, 3000 NE 151st St., AC II Rm 230, North Miami, FL 33181, USA. Brooten@fiu.edu
authors.forename: Dorothy
authors.initials: D
authors.lastname: Brooten
authors.forename: JoAnne
authors.initials: J
authors.lastname: Youngblut
authors.forename: Kathleen
authors.initials: K
authors.lastname: Blais
authors.forename: Deborah
authors.initials: D
authors.lastname: Donahue
authors.forename: Ivette
authors.initials: I
authors.lastname: Cruz
authors.forename: Michelle
authors.initials: M
authors.lastname: Lightbourne
mesh_terms: 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