(1148) Enhanced screening via EMR portal for detection of perinatal mood and anxiety disorders

Pregnant people presenting for prenatal care were randomized to RC or ES in this pilot study. Inclusion criteria included English or Spanish speaking and US-confirmed viable IUP< 14w6d. Exclusion criteria include age< 16, current psychiatric care or treatment with psychotropic medication or inability to access MyChart. ES participants received automated MyChart screening prior to prenatal visits at 12-14, 24-28, and 36 weeks and 2 and 4 weeks postpartum via Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7 questionnaires. Results were sent to the provider for the patient’s next visit; clinical care was not dictated by protocol and patients were treated and referred as clinically appropriate. 

The primary outcome was identification of clinically diagnosed PMADs defined by screening measures, ICD-10 code, initiation of SSRI or other antidepressant medication, and/or referral for psychiatric services. Secondary analyses included frequency of psychiatric referral and medication initiation.

Results:
133 people were enrolled, 70 in ES and 63 in RC. The population was racially and ethnically diverse; demographics were balanced (Table 1). Medical complications of pregnancy were more prevalent in RC. PMAD diagnoses were more prevalent in ES (27.5% vs 15.9%) but did not reach statistical significance (aOR 2.08 (0.98, 8.05), Figure 1). Anxiety disorders were diagnosed with increased frequency in ES vs RC (aOR 3.26 (1.11, 9.55)). Psychiatric referral and medication initiation were more common in ES though this did not reach statistical significance (aOR 2.12 (0.7, 6.49) and aOR 2.05 (0.62, 6.79) respectively).

Conclusion:
ES results in increased detection of anxiety disorders has potential to improve detection and treatment of all PMADs. A larger RCT is warranted.