Physician-nurse practitioner interaction patterns in primary care practices

A new method is presented which describes and measures the problem-solving and collaborative efforts between physicians and nurse practitioners on primary care teams. Application of the method would allow the relationship between team interaction and outcomes of health care to be studied. The method relates clinical problem-solving between team members to a measure of collaboration. Team interaction data were collected in a two-stage process for the purpose of tool development and refinement. Six nurse practitioner-physician teams practicing in three primary care settings participated. Audiotapes of team interactions were analyzed for initiation of interaction, character of the decision-making process that led to the interaction between providers, and characteristics of the exchange between physician and nurse practitioner. Inter-rater agreement was 0.80 for scoring of the rationale for interaction and 0.70 for collaborative scores. The findings suggest that this method is an uncomplicated clinically relevant means of allowing professionals in primary care practices to examine their own practice patterns. Trends in the data reveal little interaction between practitioners, and minimal physician initiation of exchange on the team.