Nurse-Physician Collaborations Improve Prenatal Care, Save Money
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Brooten D, Youngblut J, Blais K, Donahue D, Cruz I, Lightbourne M. APN-physician collaboration in caring for women with high-risk pregnancies. Journal of Nursing Scholarship. 2005;37:178-184.
Pregnant women with complications from diabetes, high blood pressure, preterm labor, or other conditions are at high risk for delivering their infant preterm or with low birth weight (LBW). A prenatal care intervention delivered by specially trained advanced practice nurses for a group of more than 80 high-risk pregnant women helped more of them carry their infants to term, resulting in fewer total hospital days and significant savings over the infants' first years of life.
More than 90% of the pregnant women in the program were black; 37% had less than a high school education; 83% were covered by public health insurance; and 93% reported incomes of less than $25,000 per year. The prenatal care was delivered by a team of 3 APNs who made home visits that replaced half of the usual prenatal physician or clinic visits.
Researchers conducted a secondary analysis of the logs kept by the APNs. For 92% of the cases, the APNs collaborated with the woman's physician. Of the 351 collaborative contacts, 93% were initiated by the APN, and most involved a status update to discuss lab results, wound or cerclage care, treatment adherence, or the need for ultrasound or other testing. Other reasons for contact included new physical findings, changes in treatment, concerns expressed by the woman about medications and treatment, financial constraints, or family obligations. Most of the contacts occurred in the clinic or over the telephone.
Women requiring the most collaborative contacts were more likely to have poor education and be experiencing their first pregnancy. The APNs delivering prenatal care were capable of assessing high-risk patients, negotiating the health and social systems, and working collaboratively with physicians. The intervention improved pregnancy outcomes while lowering overall costs.
Medscape Nurses. 2005;7(2) © 2005 Medscape
Cite this: Monthly Summaries of Nursing Research: August 2005 - Medscape - Aug 30, 2005.