(PO-165) (PO-165) Working Toward a More Collaborative Approach between the OB-GYN and Psychiatry Departments: A Quality Improvement Project Continued

Background:

In a prior quality improvement (QI) project, surveyed physicians identified insurance difficulties, absent electronic referral system, difficulty contacting clinics, and an unclear referral handout as barriers in our hospital’s referral process to outpatient psychiatry. With depression, anxiety, and substance use being common in the perinatal period (Gaynes, 2005), OB-GYN patients’ access to mental health treatment is important. In order to facilitate referrals, we focused on identifying and addressing barriers unique to OB-GYN patients’ referral to outpatient psychiatry clinics via an ongoing QI project.



Methods:

A survey was distributed to OB-GYN physicians within an academic hospital. They rated their confidence in their knowledge (on a 5-point likert scale) for 3 survey items: how to refer patients to the academic outpatient psychiatry clinics, how to refer to community outpatient psychiatry clinics, and ability to determine which patients are appropriate for referral. Participants were asked to identify psychiatric screening tools used in their clinics and to list barriers to outpatient psychiatry referral. In order to assess the utilization of interventions from a prior year’s QI project, participants were asked to indicate awareness of an updated referral handout and referral email address.



Results:

Over 1 month, 14 responses were collected from OB-GYN physicians (79% from residents). A majority of participants rated their confidence level as a 3 or below for their knowledge in the referral process to academic and community outpatient psychiatry clinics (86% and 93% respectively). Seventy-one percent of participants rated their confidence level in identifying patients appropriate for referral as a 3 or below. Participants identified using the following screening tools: Edinburgh Postnatal Depression scale (100%), PHQ-9 (21%), and GAD-7 (7%). Most participants indicated they were unaware of the university’s specialty perinatal psychiatry clinic (86%). Finally, most participants identified being unaware of outpatient psychiatry clinic contact information, with all participants indicating that they were unaware of a prior project’s interventions.



Discussion:

As in the literature (Kim, 2010), OB-GYN physicians at our institution reported a disconnect from outpatient psychiatry, citing difficulty reaching clinic contacts as a barrier to connecting patients to care. Interventions from a prior project were not utilized by respondents, highlighting the need to regularly update, disseminate, and better connect colleagues to referral information and screening resources.



Conclusion:

Within our hospital setting, many OB-GYN providers cite ongoing barriers to outpatient psychiatry referrals. These must be addressed to ensure patients are connected to mental health resources, to improve continuity of care, and to promote a more collaborative approach to psychiatric care.



References:

Gaynes BN, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ).2005 Feb;(119):1-8.

Kim JJ, et al. Barriers to mental health treatment among obstetric patients at risk for depression. Am J Obstet Gynecol.2010 Mar;202(3):312.e1-5.