Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago.
Psychiatr Serv. 2021 Nov 1;72(11):1268-1275. doi: 10.1176/appi.ps.202000563. Epub 2021 May 21.
The study evaluated whether implementation of perinatal collaborative care is associated with improvements in screening and treatment recommendations for perinatal depression by obstetric clinicians.
This cohort study, conducted from January 2015 to January 2019, included all women who received prenatal care in five obstetric clinics and delivered at a single quaternary care hospital in Chicago. In January 2017, a perinatal collaborative care program (COMPASS) was implemented. Completion of depression screening and recommendations for treatment following a positive depression screen were compared before and after COMPASS implementation. Adjusted analyses included inverse probability weighting by using propensity scores to impose control over imbalance between exposure groups with respect to prespecified covariates.
A total of 7,028 women were included in these analyses: 3,227 (46%) before and 3,801 (54%) after COMPASS implementation. Women who received obstetric care after implementation were significantly more likely than those who received care before implementation to receive antenatal screening for depression (81% versus 33%; adjusted odds ratio [aOR]=8.5, 95% confidence interval [CI]=7.6-9.5). After implementation, women with a positive antenatal screen for depression were more likely to receive a treatment recommendation (61% versus 44%; aOR=2.1, 95% CI=1.2-3.7). After implementation of perinatal collaborative care, combined psychotherapy and pharmacotherapy were more frequently recommended, compared with before implementation.
Implementation of a perinatal collaborative care program was associated with improvements in perinatal depression screening and recommendations for treatment by obstetric clinicians.
本研究评估了围产期协作护理的实施是否与产科临床医生改善围产期抑郁的筛查和治疗建议有关。
本队列研究于 2015 年 1 月至 2019 年 1 月进行，纳入在芝加哥一家四级保健医院分娩的五家产科诊所接受产前护理的所有女性。2017 年 1 月，实施了围产期协作护理计划（COMPASS）。比较 COMPASS 实施前后完成抑郁筛查和阳性抑郁筛查后推荐治疗的情况。调整分析包括使用倾向评分进行逆概率加权，以控制暴露组之间与预先指定协变量的不平衡。
共纳入 7028 名女性进行这些分析：实施前 3227 名（46%），实施后 3801 名（54%）。实施产科护理后的女性接受产前抑郁筛查的可能性明显高于实施前的女性（81%对 33%；调整后的优势比[aOR]=8.5，95%置信区间[CI]=7.6-9.5）。实施后，产前筛查阳性的女性更有可能接受治疗建议（61%对 44%；aOR=2.1，95% CI=1.2-3.7）。实施围产期协作护理后，与实施前相比，更常推荐联合心理治疗和药物治疗。
围产期协作护理计划的实施与产科临床医生改善围产期抑郁的筛查和治疗建议有关。
