Austin Health (Parent-Infant Research Institute) and primary care affiliates
The University of Melbourne
This implementation study evaluates a new integrated e-screening and Clinical Decision Support System (CDSS) for postnatal depression in primary care. In this cluster randomised controlled trial, half of the women will be cared for by MCHNs using the electronic platform, and half following current perinatal mental health care practices.
The online platform uses onscreen prompts to assist MCHNs in making management plans and appropriate referrals to GPs and specialist services, thus promoting data linkages between health services and collaborative, multi-disciplinary advances in clinical care pathways. Our approach integrates research evidence through a new innovation for the care of vulnerable perinatal women and infants.
The use of a novel CDSS to assist time poor clinicians following screening for emotional wellbeing at postnatal visits, has produced promising results indicating increased uptake of treatment as well as better mental health outcomes for new mothers.
Data also informed significant updates to the CDSS, and it is now being evaluated in a large implementation trial in Banyule City Council and City of Whittlesea funded by NHMRC. The study has investigated key barriers and facilitators to implement the CDSS and helped prepare for the wide-spread implementation of this system. We have also trained nurses and increased workforce capacity for screening of postnatal depression.
This project is supported by the Australian Government’s Medical Research Future Fund (MRFF) as part of the Rapid Applied Research Translation program.
A rigorously evaluated e-screening and CDSS approach compared to traditional paper-and-pencil methods will provide a tool that is acceptable and developed with user feedback that can be integrated into services to increase treatment uptake. The e-platform has the capacity to deliver real, cost-effective, sustainable improvements to the healthcare system.
This project has been successful in demonstrating that the Clinical Decision Support System (CDSS), shows promise as a tool for increasing help-seeking and improving mental health following postnatal depression screening. We have also identified key barriers and facilitators in the implementation of the CDSS and preparing the existing system for wider scale implementation. The findings of this study aided the successful achievement of an NHMRC Partnership grant to conduct a fuller implementation trial.
This study has contributed to a larger body of research into the implementation of integrated electronic screening and management of perinatal depression screening in MCH services. The overarching goal of this stream of research is to help bridge the gap between identification and referral of postnatal depression in new mothers, as screening will have little impact on mental health outcomes without stronger pathways of care. We will now have an evidence base for submission to government for potential integration into primary care. This tool bridges the gap between identification and pathways to care for perinatal depression, an important missing step