Brief Oral Papers

Child, Family, and Women's Health

Brief Oral Papers Session 15 - Women's Mental Health and Child-Adolescent Psychiatry

Development and Execution of a Remote Proactive Perinatal Telepsychiatry Service

Friday, November 8, 2024

3:10 PM – 4:25 PM EST

Location: Flager

Presenting Author(s)

Meredith Spada, MD (she/her/hers)

Assistant Professor
University of Pittsburgh
Pittsburgh, Pennsylvania

PDF

Co-Author(s)

Lauren N. kullen, MSN

Nurse Navigator
Magee Womens, UPMC Hamot
ERIE, Pennsylvania
Shelly Kucherer, MD

Assistant Professor of Psychiatry
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
Priya Gopalan, MD FACLP

Associate Professor
University of Pittsburgh Medical Center, Western Psychiatric Hospital
Pittsburgh, Pennsylvania

Abstract:

Background/Significance: Mental health conditions are a leading cause of maternal morbidity and mortality, and geographic disparities in access to care limit timely identification and management (CDC 2019). Consolidated health systems allow for innovative care models that bring highly subspecialized services from large academic centers to geographically distanced locations. In December 2023, our institution implemented a telepsychiatry perinatal consultative service to a women’s hospital 125 miles from our academic center following an initial stakeholder survey (Spada, 2022). We aimed to assess the first 3 months of that service with a focus on utilization.

Methods: We present the service's development, the algorithm for our proactive screening model, and descriptive data from the first 3 months. Utilization data was analyzed including the percentage of women screened, the percentage of women who screened positive and were offered a consult, rates of accepted consultation, and types of services delivered.

Results:  351/491 (71%) eligible birthing parents were screened. 43% of those screened were determined to be at risk for postpartum psychiatric conditions and were offered a psychiatric consult. 58/153 (37.9%) of those offered a consult accepted (9 completed in 12/23, 21 in 1/24, and 28 in 2/24). Every patient seen for consult received education on peripartum syndromes and supportive measures (e.g., sleep, nutrition), information on peripartum resources, and local crisis information. 13 patients were started on psychiatric medication (22.4%) and 12 (20.7%) were continued on medication. Most common psychiatric referrals included connection to our institution’s local behavioral health clinic (n=10, 17.2%), connection to our institution’s remote perinatal behavioral health clinic (telemedicine) (n=25, 43.1%), and connection to our institution’s perinatal intensive outpatient program (telemedicine) (n=9, 15.5%). Other services provided included referral to local domestic violence shelter (2), refugee support services (1), parenting classes (1), case management (2), and local parenting groups (2). Full analysis of the first 6 months of the clinical service will be analyzed for the conference.

Discussion:  

Results from the first three months of our growing proactive consult service to a remote labor and delivery unit show that our model is feasible, proactive, and well-utilized. A large number within our sample was determined to be at risk for postpartum psychiatric disorders. While only 38% of those offered a consultation accepted, many of the patients seen were started or continued on a medication, and all patients seen were provided psychoeducation on peripartum syndromes, peripartum resources, and offered outpatient referral for psychiatric services.

Conclusion/Implications: 

We describe our remote perinatal psychiatry consultation service at a high-volume women’s hospital within our large, consolidated health system. Our model can be modified for other institutions that wish to develop a remote perinatal telepsychiatry service.