A Needs Assessment for the Enhancement of Postpartum Depression Screening at a Primary Care Clinic in the Southwest

Abstract

Background: Despite postpartum depression (PPD) being the most common medical complication surrounding childbirth affecting 10-20% of new mothers, it is often underdiagnosed and undertreated, especially in primary care. Universal screening with a validated tool is recommended for all postpartum women as evidence shows that formal screening is superior to non-formal screening in detecting women with PPD. Unfortunately, most primary care providers do not formally screen. In southern Maricopa, low income minority women were found to have a higher than average prevalence of PPD. Thus, it is important for providers in this area to screen. Purpose: The purpose of this quality improvement project was to determine provider knowledge, practice behaviors, and perceived facilitators and barriers to PPD screening at an urban Federally Qualified Health Center in the Southwestern United States. This needs assessment was then used to make site-specific recommendations for PPD screening to enhance early identification of women with PPD. Design: A quality improvement project using a quantitative descriptive design. A quantitative survey assessed provider knowledge, practice behaviors, perceived barriers, and perceived facilitators regarding PPD screening. Setting: Wesley Health Center, a primary care clinic in Phoenix, Arizona. Participants: Five primary care providers in family practice. Results: Universal screening with validated screening tools was common. More than half of providers (60%) universally screen all postpartum women for depression with a formal screening tool up to one year postpartum. Providers were correctly using validated screening tools for PPD such as the Patient Health Questionnaire-2 (PHQ-2), PHQ-9 and Edinburgh Postnatal Depression Scale (EPDS), but only one provider (20%) was aware that the PHQ-2 and PHQ-9 are validated for that specific purpose. Wesley is already attempting to universally screen for depression with a two-step process using the PHQ-2 and PHQ-9 for all patients, but participants report that support staff sometimes forget to provide patients with the screening tool before the provider visit, patients sometimes decline to be screened, and providers either forget to catch the opportunity or do not have time. Identified facilitators to screening are support staff (80%) and the electronic health record (20%). Conclusion: One major strength of the clinic is that it already has a policy of universally screening for depression that is validated for use for PPD. The findings from the study indicate that this policy is not always followed due to barriers such as lack of time, support staff not providing screening tools before the provider encounter with the patient, and providers forgetting to screen. The screening process could be enhanced by taking the time to ensure that tools are readily accessible, gathering the input from support staff on the barriers they face to screening patients, and utilizing the electronic health record to make the process more automated. Enhancing the policy already in place would be enhancing screening practices for PPD and improve early detection of this condition. Findings will be disseminated via an executive summary and PowerPoint presentation to the staff.