Bentley Susan M, Melville Jennifer L, Berry Bianca D, Katon Wayne J
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
Gen Hosp Psychiatry. 2007 May-Jun;29(3):192-8. doi: 10.1016/j.genhosppsych.2007.01.011.
This study aimed to describe the obstacles and solutions in developing and implementing a prospective obstetric database registry that collects biopsychosocial data on women during pregnancy and postpartum. The clinical goals of the registry were to improve both diagnosis of mental health and substance use problems and access to mental health care during pregnancy. The research goals were to examine the impact of psychiatric illness and substance use on birth outcomes.
A questionnaire that contained validated instruments for mental health, substance use and psychosocial stressors was developed and administered to all pregnant women in an academic medical center obstetric clinic. Results were incorporated with reminder and decision support systems to ensure active follow-up of patients with mental health needs. Automated medical record information was collected for future analysis of outcomes.
Barriers to program implementation were overcome by a multifaceted intervention that included educational outreach to patients, providers and staff; integration of the registry into preexisting clinical protocols; reminder systems at workstations; provision of mental health decision support through perinatal social work and psychiatric consultation; and utilization of a "stepped-care" model to delivering mental health services.
A mental health registry that merges clinical and research needs can be successfully integrated into the obstetric clinic setting.
本研究旨在描述在开发和实施一个前瞻性产科数据库登记系统时所面临的障碍及解决方案，该系统收集孕期和产后妇女的生物心理社会数据。该登记系统的临床目标是改善心理健康和物质使用问题的诊断，以及孕期获得心理健康护理的机会。研究目标是检验精神疾病和物质使用对分娩结局的影响。
编制了一份包含经过验证的心理健康、物质使用和心理社会压力源评估工具的问卷，并在一家学术医疗中心的产科诊所对所有孕妇进行了调查。结果与提醒和决策支持系统相结合，以确保对有心理健康需求的患者进行积极随访。收集自动化医疗记录信息以供未来进行结局分析。
通过多方面的干预克服了项目实施中的障碍，包括对患者、医护人员和工作人员进行教育推广；将登记系统纳入现有的临床方案；在工作站设置提醒系统；通过围产期社会工作和精神科会诊提供心理健康决策支持；以及采用“逐步护理”模式提供心理健康服务。
一个融合临床和研究需求的心理健康登记系统能够成功整合到产科诊所环境中。
