(203) Stakeholder Assessment for a Remote Perinatal Telepsychiatry Service

Abstract: Background/Significance: Internationally, women in areas with limited health access are at higher risk for postpartum depression and anxiety in comparison to urban cities, stemming from disparities in access to care (Mollard, 2015). Emerging data shows telepsychiatry consultations to rural obstetrical units can help bridge this gap in areas without access to perinatal psychiatry resources (Gopalan, 2021). Consolidated health systems allow for innovative models of care that bring highly subspecialized care from large academic centers to geographically distanced locations. Our institution is implementing a telepsychiatry perinatal consultative service to a women’s hospital 125 miles from our academic center with approximately 2000 deliveries per year. We aim to obtain stakeholder input prior to initiation of this service.

Methods: We performed a needs assessment of local stakeholders to obtain input prior to implementation of a perinatal telepsychiatry consultation-liaison service. An anonymous, electronic survey was sent to assess comfort, knowledge, and attitudes towards patients with psychiatric illness. This project was approved by the University of Pittsburgh Quality Improvement Review Committee.

Results: 31 responses were recorded (80.1% nurses; 16.1% nurse practitioners/physician assistants; 3.2% physicians). Respondents indicated that the following areas were most relevant to their patients: depression (n=29), anxiety (n=29), opioid use (n=26), trauma (n=20), other substances (n=19), and perinatal loss (n=18). 25.8% felt uncomfortable taking care of patients with mental health concerns. 22.2% of those who prescribe medications indicated comfort in starting an SSRI for perinatal patients; 25% felt comfortable managing medication for opioid use disorder. Respondents demonstrated knowledge deficits for perinatal psychiatry (e.g., 6.4% responded correctly that psychiatric conditions are the most common complication of delivery). 51.7% indicated that patients with mental health issues are harder to care for than those without. The majority thought their patients would benefit from access to telepsychiatry services (90.3%) and would welcome access to telepsychiatry services (93.5%).

Discussion: Staff indicated that mental health and substance use conditions were relevant to their practice. Identified low comfort in perinatal mental health suggests a need for education on perinatal psychiatric conditions. Results of this survey will be presented alongside administrative processes in clinical service development.

Conclusion/Implications: Our stakeholder survey suggests a need for telemedicine perinatal psychiatry consultation services at a high volume remote women’s hospital within our large, consolidated health system. Targeted educational interventions for staff will be developed alongside clinical service development.

References:

Mollard E, Hudson DB, Ford A, Pullen C. An Integrative Review of Postpartum Depression in Rural U.S. Communities. Arch Psychiatr Nurs. 2016 Jun;30(3):418-24. doi: 10.1016/j.apnu.2015.12.003. Epub 2015 Dec 17. PMID: 27256951.

Gopalan P, Auster L, Brockman I, Shenai N. Consultation-Liaison Telepsychiatry on an Inpatient Obstetrical Labor and Delivery Unit. J Acad Consult Liaison Psychiatry. 2021 Nov-Dec;62(6):577-581. doi: 10.1016/j.jaclp.2021.04.001. Epub 2021 Apr 20. PMID: 33972195.