Evaluation and Revision of a Postpartum Depression Screening Program in a Military Pediatric Outpatient Setting

Abstract

Summary: The role of the pediatric provider is widening to include maternal screening for postpartum depression (PPD). A quality improvement project was performed to examine a military pediatric clinic’s current PPD screening practice to determine provider compliance and recommend a performance-improvement plan. The project also sought to answer the proposed inquiry question: “Does postpartum depression education and an established referral protocol increase screening compliance rates in the military pediatric primary care setting?” Procedure: There were three phases in this project. The first phase involved a review of the current PPD screening procedure at the clinic. The current procedure called for administrating the Edinburgh Postnatal Depression Scale to all mothers during their infants’ 2-week well-baby visits. The second phase included a chart audit on infant’s 2 week well child visits from August 3-14 and November 5-16, 2015. A provider questionnaire regarding attitudes and beliefs on PPD screening and minimal demographic information was emailed via SurveyMonkey in September. The clinic’s staff received a brief educational presentation on PPD and screening in the pediatric setting in October 2015. The second chart audit collection period started one week following the last presentation. The final phase of the project consisted of policy sustainability, data dissemination and publication. Results: Of the 42 charts reviewed in the first audit, 93% had completed PPD screenings. There were four charts (10%) with a positive screening score of 10 or greater, and one received a mental health referral that day. The second chart audit included 33 charts with 94% indicated completed PPD screenings. Positive screenings were indicated in two charts (6%) and one chart had documented referrals to a mental health provider. Responses to the provider questionnaire were overall positive. A majority of the providers (83%) agreed that PPD is important in this setting, all responded that they are comfortable with referral as needed, yet none felt comfortable with treatment of the mother for PPD. Discussion: Overall, collection rates for the clinic were very high and PPD rates were similar to expected national averages. The results support the feasibility of PPD screening in the pediatric setting but did not support the proposed question. In this setting, the education did not increase the screening rates. Although, the pre-educational rate was already very high.