Outcomes of Implementing Routine Screening and Referrals for Perinatal Mood Disorders in an Integrated Multi-site Pediatric and Obstetric Setting

Puryear, Lucy J.; Nong, Yen H.; Correa, Nancy; Cox, Ken; Greeley, Christopher S.

doi:10.1007/s10995-019-02780-x

Cited by 18 publications

(14 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the other hand, co‐locating care, and therefore increasing interaction and patient care management plans between obstetricians and HBV specialists, may not only improve care delivered during pregnancy, but may also improve linkage to care for future maternal and infant health. As demonstrated in other liver disease and obstetrics contexts, 27–30 care co‐location improves disease outcomes, and may take the form of co‐located established clinic, visiting provider in the obstetrics context, or pregnancy clinic held within the liver diseases practice. The ultimate goal of these types of practices is to reduce variance and outliers in care, so that care is uniformly provided to all patients (regardless of insurance, demographics or health history), and value‐based care models are integrated into practices across the country 31 .…”

Section: Discussionmentioning

confidence: 99%

Adherence to pregnancy hepatitis B care guidelines in women and infants in the United States and evaluation of two interventions to improve care: A multicentre hospital‐based study

Kushner

Kaplowitz

Mei

et al. 2021

Journal of Viral Hepatitis

View full text Add to dashboard Cite

There has been an increase in hepatitis B (HBV) detection during pregnancy in the United States and an emphasis on measures to decrease mother‐to‐child transmission of HBV. We performed a multicentre retrospective study (2015–2018) evaluating care among all women with HBV during pregnancy. We determined rates and predictors of adherence to key maternal care measures including: (1) referral to HBV specialty care, (2) assessment of HBV DNA, and (3) initiation of antiviral therapy, and (4) rates of HBIG and HBV vaccine completion in infants. We evaluated two interventions to improve HBV care: (1) clinical decision support with best practice alert and (2) co‐location of HBV care in obstetrics department. We identified 372 women with HBV during pregnancy. Patients had a median age of 33 (IQR 29, 36), were mostly of Asian (49%) or Black (36%) race, HBeAg‐negative (83%) with HBV DNA ≤2000 IU/mL (65%) and maximum ALT ≤25 (66%). Regarding care measures, 62% were referred to an HBV specialist, 85% had HBV DNA checked during pregnancy and 68% with HBV DNA ≥200,000 were initiated on antiviral therapy. Co‐located obstetric‐liver diseases clinics appeared to improve adherence to maternal care measures. All infants received HBIG and the first HBV vaccine dose, 106 (81%) received the second, 94 (74%) received the 3rd dose, but fewer at the recommended time intervals. We identified clear gaps in adherence to HBV care measures for both mothers and infants. Co‐location of HBV care in the obstetrics department shows promise in improving adherence to maternal care measures.

show abstract

Section: Discussionmentioning

confidence: 99%

Adherence to pregnancy hepatitis B care guidelines in women and infants in the United States and evaluation of two interventions to improve care: A multicentre hospital‐based study

Kushner

Kaplowitz

Mei

et al. 2021

Journal of Viral Hepatitis

View full text Add to dashboard Cite

show abstract

“…To date, routine perinatal mental health screening has been inadequately implemented creating a critical gap in maternity health care (34). The implementation of screening programs within antenatal services is often inconsistent as it requires action from different departments within the health service and across disciplines of health professionals.…”

Section: Discussionmentioning

confidence: 99%

Introducing and Integrating Perinatal Mental Health Screening: Development of an Equity-informed Evidence-based Approach

Blackmore

Boyle

Gray

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Pregnancy is a time of increased risk for developing or re-experiencing mental illness. Perinatal mental health screening for all women is recommended in many national guidelines but a number of systems-level and individual barriers often hinder policy implementation. These barriers result in missed opportunities for detection and early intervention, and are likely to be experienced disproportionately by women from culturally and linguistically diverse backgrounds, including women of refugee backgrounds. The objectives of this study were to develop a theory-informed, evidence-based guide for introducing and integrating perinatal mental health screening across health settings; and to synthesise the learnings from an implementation initiative and multi-sectoral partnership between the Centre of Perinatal Excellence (COPE), and a university-based research centre. COPE is a peak body in perinatal mental health and Non-Governmental Organization commissioned to update the Australian national perinatal mental health guidelines, train health professionals and rollout innovative digital screening across healthcare settings. Methods: In this case study, barriers to implementation were prospectively identified and strategies to overcome them were developed. A pilot perinatal screening program with a strong health equity focus was implemented and evaluated at a large public maternity service delivering care to a culturally diverse population of women in metropolitan Melbourne, Australia, including women of refugee background. Strategies identified pre-implementation and post-evaluation were mapped to theoretical frameworks. An implementation guide was developed to support future policy, planning and decision-making by healthcare organisations. Results: Using a behavioural change framework (COM-B), the key barriers, processes, and outcomes are described for a real-world example designed to maximise accessibility, feasibility, and acceptability. A program logic model was developed to demonstrate the relationships of the inputs, which included stakeholder consultation, resource development, and a digital screening platform, with the outcomes of the program. A seven-stage implementation guide is presented for use in a range of healthcare settings. Conclusions: These findings describe an equity-informed, evidence-based approach that can be used by healthcare organisations to address common systems and individual level barriers to implement perinatal mental health screening guidelines.

show abstract

“…Beginning in 2014, the Texas Children's Hospital (TCH) Health System underwent a quality improvement initiative to increase detection of PPD and access to maternal mental health services through universal screening for PPD at obstetric and paediatric practices and by facilitating referrals to reproductive psychiatry for evaluation and treatment (Puryear et al, 2019). The psychiatrist provided medication, therapy, and/or referred the mother to other specialists or treatment as appropriate.…”

Section: Introductionmentioning

confidence: 99%

“…The psychiatrist provided medication, therapy, and/or referred the mother to other specialists or treatment as appropriate. During this initiative, providers found that Black, Latina, and women on Medicaid during pregnancy were significantly less likely to attend at least one visit with a psychiatrist compared to women who were White, non‐Hispanic, and using commercial insurance (Puryear et al, 2019). Additionally, women referred by paediatricians located in a different location than the psychiatrist had a 21% appointment completion rate compared to an 83% completion rate when the referrals were made to psychiatry services in the same location as the referring provider.…”

Section: Introductionmentioning

confidence: 99%

A promising new model of care for postpartum depression: A randomised controlled trial of a brief home visitation program conducted in Houston, Texas, USA

Horne

Nong

Cain

et al. 2021

Health Social Care Comm

Self Cite

View full text Add to dashboard Cite

Postpartum depression (PPD), a perinatal mood and anxiety disorder (PMAD), is a leading cause of complications of pregnancy and childbirth. In the United States, approximately 20 percent of women suffer from PMADs. In Houston, Texas, an estimation of 12,000 -15,000 women experience PPD each year. Within the Texas Children's Paediatrics network, a large paediatric network located in Houston, Texas, mothers are screened during paediatric well-child visits and those screening positive receive a referral to a psychiatrist with the network. However, there are not enough psychiatrists to meet the demand of services and Black, Latina, and women on Medicaid during pregnancy are less likely to attend a psychiatric visit compared to White, non-Hispanic women. This study used a randomised control trial design to measure the effectiveness of an alternative treatment option for a racially diverse population of postpartum women with mild to moderate symptoms of PPD, a five-session home visitation program using the Problem-Solving Tools for PPD (PST4PPD) model delivered by master's level social workers. The control group was allocated to standard treatment with a psychiatrist. A total of 118 women gave consent and were randomised, 72 to home visiting and 46 to psychiatry. Results demonstrated that all participating mothers had significant decreases in PPD symptoms. The change in PPD symptoms among those in the home visitation program was not significantly different from the change in the control condition, indicating that the home visitation program was as effective as psychiatric treatment in significantly reducing PPD symptoms. Additionally, a high proportion of women in the home visitation program completed visits and demonstrated increased maternal self-efficacy. Based on these results, a short-term home visitation program by a social worker (PST4PPD) appears to be a promising treatment option for postpartum women with mild to moderate PPD symptoms.

show abstract

Outcomes of Implementing Routine Screening and Referrals for Perinatal Mood Disorders in an Integrated Multi-site Pediatric and Obstetric Setting

Cited by 18 publications

References 13 publications

Adherence to pregnancy hepatitis B care guidelines in women and infants in the United States and evaluation of two interventions to improve care: A multicentre hospital‐based study

Adherence to pregnancy hepatitis B care guidelines in women and infants in the United States and evaluation of two interventions to improve care: A multicentre hospital‐based study

Introducing and Integrating Perinatal Mental Health Screening: Development of an Equity-informed Evidence-based Approach

A promising new model of care for postpartum depression: A randomised controlled trial of a brief home visitation program conducted in Houston, Texas, USA

Contact Info

Product

Resources

About