Screening and Follow-Up Care for Perinatal Mood and Anxiety Disorders at a Rural Obstetric Clinic.

ABSTRACT

OBJECTIVE: To improve screening for perinatal mood and anxiety disorders (PMAD) and follow-up care while balancing team workload. DESIGN: Four rapid plan-do-study-act cycles were implemented over 8 weeks. SETTING/LOCAL PROBLEM: At baseline, only 2% of patients with PMAD were identified at a rural obstetric clinic, and none (n = 0 of 50) received screening with a validated tool. Of the 12 patients who had a current or prior history of PMAD, 92% (n = 11) were not screened for self-harm, and 67% (n = 8) received no referral. The clinic had no standardized care for PMAD. PARTICIPANTS: Patients (n = 253) screened at initial pregnancy intake, early in the third trimester, and at the 6-week postpartum visit. INTERVENTION/MEASUREMENTS Following the screening, brief intervention, and referral to treatment model, patients were screened using the Edinburgh Postnatal Depression Scale, and brief intervention and referral to treatment were used with a point-of-care checklist. Data were collected three times weekly for run chart analysis, and team surveys measured workload. RESULTS: At the end of 8 weeks, effective screening for PMAD and follow-up care were achieved for 98% of patients and included screening, education, shared decision-making for management, referral, and clinic and phone follow-up to support mental health care uptake. CONCLUSIONS: Standardizing screening and follow-up care can increase identification of PMAD and increase uptake of mental health care. For sustainability, a decision aid can streamline patient-provider communication and reduce visit length.