The PRogram In Support of Moms (PRISM): Increasing obstetric practice capacity to implement the depression care...

Perinatal depression is common yet undertreated. The Massachusetts Child Psychiatry Access Program (MCPAP) for Moms is a state-wide program to improve access to perinatal depression care by providing training, consultation, and referrals to healthcare professionals serving perinatal women. The PRogram In Support of Moms (PRISM) includes MCPAP for Moms plus practice-level implementation support. This cluster randomized controlled trial compared MCPAP for Moms vs. PRISM in implementation of the perinatal depression care pathway, inclusive of screening, assessment, treatment, follow-up and monitoring, and transition of care.

Ten obstetric practices were randomized to MCPAP for Moms or PRISM. We abstracted medical record data for perinatal individuals enrolled in the study with elevated depression symptoms (n = 294). Generalized linear mixed-effects models, accounting for clustering of practices, compared post-intervention implementation of the depression care pathway. We also examined changes in implementation via practice leadership surveys.

Patients in PRISM practices were more likely to be screened for bipolar disorder (OR = 385.0, p = .001), have treatment engagement documented (OR = 2.8, p = .011), receive follow-up monitoring (OR = 4.0, p = .003), and receive a transition of care plan (OR = 2.7, p = .016). Patients in PRISM practices were more likely to be identified as having perinatal depression (OR = 2.3, p = .001). Practice leadership reported greater increase in capacity to address perinatal depression in PRISM practices (3.7 points, p = .005).

PRISM was associated with greater depression care pathway implementation and improved identification of patients with perinatal depression. In order to help implement new initiatives (i.e. bipolar disorder screening) aligned with the depression care pathway, practice-level assistance may be needed.