Duke University School of Nursing, Duke University, Durham, North Carolina.
Avista Women's Care, Louisville, Colorado.
J Midwifery Womens Health. 2021 Jul;66(4):534-539. doi: 10.1111/jmwh.13215. Epub 2021 May 24.
Perinatal mood and anxiety disorders are the most common complication during pregnancy and postpartum. Screening, diagnosis, and treatment for these disorders are inhibited by limited mental health resources for patients and health care providers, lack of provider training, and time constraints. Systematic screening combined with onsite mental health consultation is an evidence-based method to increase timely diagnosis and treatment. The purpose of this quality improvement project was to promote and improve onsite mental health consultations through the implementation of a systematic screening guideline.
The systematic screening guidelines included administration of the Patient Health Questionnaire-9 at the perinatal intake visit, the Edinburgh Perinatal Depression Scale between 28 and 32 weeks' gestation and again between 2 and 8 weeks postpartum. The guidelines included onsite mental health consultations for eligible women. Screening rates, attended onsite mental health consultations, and health care provider satisfaction and feedback surveys were collected over a 3-month period, before and after guideline implementation.
Perinatal mood and anxiety disorder screening rates were significantly increased from 24.9% to 64.2% (P < .001) at the perinatal intake visit and in the third trimester from 0.3% to 32.8% (P < .001) with the implementation of a systematic screening guideline. Onsite mental health consultations significantly increased from 7.2% to 15.2% (P < .001). Perinatal care providers (n = 9, 100%) were satisfied with the screening guideline and reported that it added 5 minutes or less to their office visits.
The implementation of a systematic perinatal mood and anxiety disorder screening guideline increased completed screenings in the perinatal period and increased the number of attended onsite mental health consultations. Systematic screening combined with onsite mental health consultation is a successful way to identify at-risk women and offer critical and convenient maternal mental health care without increasing the burden on perinatal care providers.
围产期情绪和焦虑障碍是妊娠和产后最常见的并发症。由于患者和医疗保健提供者的精神卫生资源有限、提供者培训不足以及时间限制，这些障碍的筛查、诊断和治疗受到了阻碍。系统筛查结合现场心理健康咨询是一种提高及时诊断和治疗的循证方法。本质量改进项目的目的是通过实施系统筛查指南来促进和改善现场心理健康咨询。
系统筛查指南包括在围产期就诊时进行患者健康问卷-9 调查、在妊娠 28-32 周和产后 2-8 周进行爱丁堡产后抑郁量表调查，以及为符合条件的女性提供现场心理健康咨询。在实施指南前后的 3 个月内，收集围产期情绪和焦虑障碍筛查率、参加现场心理健康咨询的情况、医疗保健提供者满意度和反馈调查。
通过实施系统筛查指南，围产期就诊时的围产期情绪和焦虑障碍筛查率从 24.9%显著提高到 64.2%（P<.001），妊娠晚期从 0.3%提高到 32.8%（P<.001）。现场心理健康咨询显著增加了 7.2%到 15.2%（P<.001）。9 名（100%）围产期护理提供者对筛查指南表示满意，并报告称该指南为他们的就诊增加了不到 5 分钟的时间。
实施系统的围产期情绪和焦虑障碍筛查指南增加了围产期的完成筛查数量，并增加了现场心理健康咨询的数量。系统筛查结合现场心理健康咨询是一种成功的方法，可以识别高危妇女，并提供关键和便利的产妇心理健康护理，而不会增加围产期护理提供者的负担。
