Doering Jennifer J, Wichman Christina L, Laszewski Audrey, Kuehn Shelby, Ke Weiming
College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA.
Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Birth. 2023 Dec;50(4):764-772. doi: 10.1111/birt.12722. Epub 2023 Mar 20.
Screening and treatment initiation for perinatal psychiatric conditions is a recommended competency in OB/GYN practitioners, yet perinatal psychiatry is rapidly evolving. Practitioner-to-psychiatrist consultation programs have the potential to improve the management of psychiatric conditions in perinatal women. This study describes utilization of a statewide perinatal psychiatric consultation service by OB/GYN practitioners through examination of the volume, responsivity, content and outcomes of clinical inquiries, and satisfaction.
This quality improvement study describes the 460 telephone or e-mail consultations requested by OB/GYN practitioners over 2 years and housed within a REDCap database. Data include the characteristics of consult users, month-over-month and total utilization, the patient's perinatal status, the reason for contact, current symptoms and medications, and the consulting psychiatrist recommendations. Practitioner satisfaction with consultation is also described.
After completion of triage, the psychiatrist returned the practitioner's call ≤5 min in 59% of consultations. The most common inquiries were for pregnant (64%) women for depressive (51%) or anxiety (46%) symptoms with 47% of inquiries reporting the patient was currently taking a psychiatric medication. Had consultation not been available, referral to mental health (41%) or starting a medication (15%) were most often reported.
This perinatal psychiatric consultation service rapidly and effectively met the needs of practitioners practicing in OB/GYN settings across a state having a critical psychiatry shortage and varying urban and rural geography. Future recommendations include the assessment of direct patient outcomes, practitioner skill attainment, and long-term cost savings of this perinatal psychiatric consultation model.
围产期精神疾病的筛查和治疗启动是妇产科医生推荐应具备的能力，然而围产期精神病学正在迅速发展。医生与精神科医生的咨询项目有潜力改善围产期妇女精神疾病的管理。本研究通过检查临床咨询的数量、响应性、内容和结果以及满意度，描述了妇产科医生对全州围产期精神科咨询服务的利用情况。
这项质量改进研究描述了两年内妇产科医生提出的460次电话或电子邮件咨询，并存储在REDCap数据库中。数据包括咨询用户的特征、逐月和总利用率、患者的围产期状况、联系原因、当前症状和用药情况，以及咨询精神科医生的建议。还描述了医生对咨询的满意度。
在完成分诊后，精神科医生在59%的咨询中在≤5分钟内回复了医生的电话。最常见的咨询是针对怀孕（64%）妇女的抑郁（51%）或焦虑（46%）症状，47%的咨询报告患者目前正在服用精神科药物。如果没有咨询服务，最常报告的是转介至心理健康机构（41%）或开始用药（15%）。
这项围产期精神科咨询服务迅速有效地满足了该州妇产科环境中医生的需求，该州存在严重的精神科医生短缺问题，且城乡地理环境各异。未来的建议包括评估该围产期精神科咨询模式对直接患者结局、医生技能提升和长期成本节约的影响。
