|
Continued from Page
2
In "Interventions to Promote Collaboration Between
Nurses and Doctors," published last year in The
Cochrane Library, Merrick Zwarenstein, MD, reviews the
results of two short-term randomized trials of doctor-nurse
collaborations in hospital care settings.
In the first trial, doctors, nurses and other health
care professionals made decisions together regarding
patient care for a period of six months. Among the 1,945
patients studied, the length of hospital stay decreased
from six to 5½ days, and hospital charges lowered
from $8,000 to $6,700.
The second trial compared length of hospital stays
in two female wards for a period of three months.
Length of hospital stays shortened slightly, from 12
to 10½ days, in the ward with nurse intervention.
"While the results of these studies are not sufficiently
convincing in and of themselves … the findings
are promising," Zwarenstein, senior scientist at
the University of Toronto and the Institute for Clinical
Evaluative Sciences in Toronto, explained. "A concerted
effort should be mounted to develop and test these and
other interventions to promote improved health care
quality, efficiency and outcomes through doctor-nurse
collaborations. They suggest that it is worth doing
more rigorous studies of interventions to improve nurse-doctor
collaborations."
A more thorough study, "Can Nurse Practitioners
and Physicians Beat Parochialism into Plowshares?"
explores both the history of the NP role in the U.S.
health care system, its evolution and what is being
done on a policy level to increase the presence of NPs
in the workplace and doctor-nurse collaborative practices.
The study, conducted by the Robert Graham Center and
published in the September/October 2002 issue of Health
Affairs, claims that doctors and nurses often fight
for control over issues such as scope of responsibilities,
insurance reimbursement and prescription privileges,
rather than work together. Lead researcher Robert Phillips,
MD, and colleagues write, "Far too often, nurse
practitioner and physicians professional organizations
do not work together, but rather expand considerable
effort jousting in political arenas."
Phillips, the center's assistant director and the lead
researcher, is quick to propose a solution to this problem.
He wrote that "physician-NP relationships could
evolve by … removing barriers that prevent [NPs]
from being fully functional members of collaborative
health care teams."
The study lists the results of limited research on
doctor-NP collaboration programs.
"Studies of NP-physician teams have demonstrated
cost and quality-of-care improvements in nursing homes,
ERs and surgical inpatient settings. Disease prevention
and care of chronic conditions also benefit from NP-physician
teams. Physicians who work with NPs report improved
job satisfaction, reduced workloads and increased ability
to offer a higher standard of care."
The researchers highlight several examples of public
policy programs to improve the presence of nurses in
the workplace being developed at institutions nationwide,
including the University of Houston's Greater Houston
Partnerships for Quality Education; partnerships in
training at the University of California, Davis and
University of California, San Francisco; the Area Health
Education Centers programs, taking place in four states
and funded by the U.S. Department of Health & Services;
and Community Partnerships in Health Professions Education,
taking place at universities in seven states and funded
by the W.K. Kellogg Foundation.
Empirical proof that one method of doctor-NP collaboration
works better than another is limited, according to the
Robert Graham Center. "Evidence is lacking on how
best to distribute patient-care functions within a collaborative
team and how to improve providers' willingness or ability
to collaborate," the study states.
Yet, researchers make myriad suggestions, such as more
education for NPs and changes in regulations and payment
policies that would allow NPs to write more prescriptions
and receive more insurance reimbursements. These changes
would lead to stronger relationships with doctors, more
opportunities for treating patients and improved all-around
quality of care, researchers say.
Contact Radha McLean at radhaam@hotmail.com
|
Reply
to Article