| Description |
Background: Screening for postpartum depression has traditionally been completed at the six-week postpartum visit. Postpartum depression, however, can occur anytime within the first year after giving birth and, when untreated, can have devastating effects. For this reason, multiple organizations recommend screening for postpartum depression at well-child visits. Current evidence indicates that utilizing well-child visits as a postpartum screening and referral platform can improve outcomes. Local Problem: A rural, privately-owned family medicine clinic in Idaho lacks a specific process for screening and referring for postpartum depression at well-child visits. Methods: We implemented a quality improvement project in a rural Idaho family medicine clinic from November 1, 2024, through December 31, 2024. The project focused on screening women bringing their newborns in for well-child visits in the first year of life for postpartum depression. We conducted semi-structured interviews and inductive thematic analysis to determine preexisting screening practices. We established baseline screening and referral rates through a review of the electronic health record (EHR) for two months, from August 1, 2024, to September 30, 2024. Then, we assessed screening and referral rates after implementation, and interviewed providers to determine the new process's usability, feasibility, and user satisfaction. Interventions: Using the Johns Hopkins Evidence-Based Practice Model, Plan-Do-Study-Act (PDSA) cycles, current evidence, and provider input, we developed clinic-specific guidelines for postpartum depression screening and referral at well-child visits. The guidelines directed the front office staff to provide a modified Edinburgh Postnatal Depression Scale (EPDS) to qualified patients which would then be reviewed by the physician. Those who scored positive for postpartum depression were given options for referral and/or treatment. Results: Before implementation, none (0%, 0/25) of the charts reviewed had documented any postpartum depression screening or referral. After implementation, 82.6% (19/23) of charts demonstrated that postpartum depression screening and referral occurred. Interview themes included perceived barriers before implementation and suggestions for improvements after implementation. All providers found the clinic-specific guidelines for postpartum depression screening and referral usable, feasible, and satisfactory. Conclusion: Despite recommendations for postpartum depression screening at well-child visits, the literature shows that rates remain low. Through this quality improvement project, we demonstrated that implementing a postpartum depression screening and referral process could increase screening and referral rates for postpartum depression in mothers in the first year after giving birth. The literature also indicates that an increase in postpartum depression screening may lead to improved outcomes for the mother, baby, and family. Our hope is that other clinics can use these methods and interventions to improve outcomes at their clinics. |
