General practitioner perceptions and experiences of managing perinatal mental health: a scoping review.

BACKGROUND: General Practitioners (GPs) are involved in preconception, pregnancy, and postnatal care. Overall, mental health remains a significant contributor to disease burden affecting 1 in 4 pregnant women. Psychotropic medication prescribing occurs in almost 1 in 12 pregnancies, and appears to be increasing, along with the prevalence of mental health disorders in women of reproductive age. Perinatal mental health management is therefore not an unlikely scenario within their clinical practice. This scoping review aims to map current research related to GPs perceptions and experiences of managing perinatal mental health. METHOD: A comprehensive search strategy using nine electronic databases, and grey literature was undertaken between December 2021 and February 2023. Relevant studies were sourced from peer review databases using key terms related to perinatal mental health and general practitioners. Search results were screened on title, abstract and full text to assess those meeting inclusion criteria and relevance to the research question. RESULTS: After screening, 16 articles were included in the scoping review. The majority focused on perinatal depression. Findings support that GPs express confidence with diagnosing perinatal depression but report issues of stigma navigating a diagnosis. Over the last two decades, prescribing confidence in perinatal mental health remains variable with concerns for the safety profile of medication, low level of confidence in providing information and a strong reliance on personal experience. Despite the establishment of perinatal guidelines by countries, the utilisation of these and other existing resources by GPs appears from current literature to be infrequent. Many challenges exist for GPs around time pressures, a lack of information and resources, and difficulty accessing referral to services. CONCLUSION: Recommendations following this scoping review include targeted perinatal education programs specific for GPs and embedded within training programs and the development of practice guidelines and resources specific to general practice that recognises time, services, and funding limitations. To achieve this future research is first needed on how guidelines and resources can be developed and best delivered to optimise GP engagement to improve knowledge and enhance patient care.

The Patterns of Antipsychotic Use for Pregnant Women Over a 16-year Timeframe in an Australian Principal Referral and Specialist Women and Newborn Hospital.

The purpose of the study is to analyse the patterns of antipsychotic use for pregnant women in an Australian Principal Referral and Specialist Women and Newborn Hospital. This retrospective, observational study involved an analysis of dispensing data of antipsychotics from 1998 to 2014 extracted from the pharmacy dispensing systems. The study included 282 antipsychotic dispensings in the years 1999 to 2006 and 3041 dispensings in the years 2007 to 2014. Second-generation antipsychotic use during pregnancy increased over time, while first-generation-antipsychotics showed declining trend. The use of quetiapine has increased from 2.9% of total antipsychotic dispensings in 2002 up to 77.9% of total antipsychotic dispensings in 2008. Olanzapine use decreased from 78.1% in 2003 to around 20% since 2006. When comparing the age distribution, there was an increased proportion of patients receiving antipsychotics in the 30-39 age range in the second period of 2007 to 2014 compared to 1999 to 2006. The proportion of women on more than one antipsychotic increased from 5% (n = 8) to 9.8% (n = 81) when comparing between 1999 and 2006 and between 2007 and 2014. Our findings indicate a significant shift in prescribing patterns over the study period, with the increased use of antipsychotics, particularly the emergence of SGAs from 2007, changing trends in the use of specific medications as published findings on their safety profiles becomes evident, and more polypharmacy prescribing.

Analysis of Perinatal Women Attending a Mother and Baby Unit Taking Sodium Valproate or Lithium with a Diagnosis of Bipolar Affective Disorder.

In this study we describe the management of postnatal women with a bipolar disorder diagnosis who were prescribed either lithium or sodium valproate. There was a 38.2% (13 out of 34) relapse rate in patients discharged on lithium, compared to 46.7% (14 out of 30) relapse in patients discharged with valproate. Only 20 women (29.9%) continued to breastfeed at discharge. There were 32 (47.8%) who ceased breastfeeding during their MBU admission and 23 (34.3%) of whom ceased due to initiation of lithium therapy.

Analysis of a Pharmacy Developed, Outpatient Lactation Consultant Initiated Domperidone Programme.

BACKGROUND: Domperidone is a commonly prescribed galactagogue used off-label for lactation insufficiency. Prescriber unfamiliarity or safety concerns can lead to therapeutic delay and potential early breastfeeding discontinuation. To facilitate access, the study site pharmacy department developed a Structured Administration and Supply Arrangement (SASA) for International Board-Certified Lactation Consultants (IBCLC) to screen and initiate domperidone using a checklist. MATERIAL: To validate a domperidone screening tool via analysis of its use and compliance, together with a staff satisfaction survey. METHODS: Records were extracted from the REDCap® database for women with documented domperidone supply between 06/05/2022 and 27/01/2023 and reviewed with medical records. A staff survey was distributed assessing compliance and attitudes towards the SASA. RESULTS: Records of supply revealed that 34% (17/50) of patients were referred to a physician, revealing a discrepancy between database documentation and checklists, as no referrals were documented. Overall staff satisfaction with the SASA was rated 4.6 out of 5. 77.7% (7/9) felt confident counselling and supplying domperidone with the SASA in place. 88.9% (8/9) felt confident using the checklist to identify the appropriateness of therapy and referral to a physician. CONCLUSIONS: The system in place allows the IBCLCs to initiate and supply domperidone in a timely manner to breastfeeding mothers with lactation insufficiency. The support tools, including domperidone SASA, REDCap® documentation database and the checklist domperidone as a Galactagogue Checklist, can be greatly appreciated by the LCs. Continued discussion with IBCLCs to refine and improve the SASA and associated education package will result in more consistent compliance.

Pharmacist clinical interventions: Five years' experience of an efficient, low-cost, and future-proofed tool.

OBJECTIVE: The objective of this study was to describe the development of an efficient and future-proofed tool for the documentation and analysis of clinical interventions (CIs). A secondary objective was to describe CIs recorded over a 5-year period and describe implications of the tool. METHOD: In 2016, a matrix guide and an advanced spreadsheet were implemented in the study hospital to document all CIs made by pharmacists. The data entry tabs are arranged by month. The summary report dashboard tab provides an automatically generated analysis of the real-time data following pharmacists entering the CI details. RESULTS: A total of 10,855 CIs were documented over the 5 years period starting from March 2016 to February 2021. The real-time data were utilised for multiple quality improvement initiatives including medical and nursing education, development of business cases and progress monitoring of newly established services. The tool was able to adapt with changes in devices, business intelligence software and migration to cloud storage. CONCLUSION: The study demonstrates the feasibility of developing a low-cost and low-resource CI documentation tool. This tool provides data with the capability to inform site-specific education strategies, monitor quality improvement services and inform management in business case preparation.

Long-acting injectable antipsychotic treatment during pregnancy: Outcomes for women at a tertiary maternity hospital.

Our study aimed to examine pregnancy, neonatal and psychosocial outcomes for women treated with LAIs at tertiary maternity hospital. A retrospective review of all women who were treated with LAIs between 1999 and 2017. Cases were identified via the hospital dispensary system and outcome data were extracted case notes as well as the midwifery notification system. Measures included sociodemographic data, smoking, alcohol and illicit substance use, pregnancy complications such as gestational diabetes, and neonatal outcomes. Psychosocial profiles such as psychiatric admission during pregnancy and statutory child protection involvement were also assessed. Where available, outcomes were compared with state population data. The study found 38 pregnancies to 36 women, who had LAI treatment. Two congenital malformations (5.7%) were recorded. Compared to general population data, pregnant women treated with LAIs were more likely to have obstetric complications including gestational diabetes and pregnancy hypertension and special care nursery admission for their babies. They also had elevated rates of psychiatric admissions during pregnancy and statutory child protection involvement. Outcomes were similar first and second generation LAIs exposure. As women on LAI have limited options for treatment of their psychotic disorders, the findings point towards a need for enhanced multidisciplinary pregnancy care for this vulnerable cohort.