Estimate the scope of behavioral health need among women beginning pregnancy care by an EMR-based assessment

Background: It is well-recognized that behavioral health problems are under detected and undertreated in primary care. Medical settings have been identified as likely settings to detect and address these problems, but any such efforts would require a strategic approach based on needs in the treated population. Obstetric settings are being encouraged to detect and address behavioral health needs. Methods: An EMR-based approach for developing an initial estimate of the portion in need, and the range of conditions present, was developed for the obstetric setting. A list was developed of behavioral health diagnoses and prescriptions that could be queried using the electronic medical record (EMR). For diagnoses, the ICD-9 set of "mental disorder" diagnoses (codes 290-319) was used. For prescriptions, a list of behavioral health medications published by NIMH was used, augmented with the behavioral health medications noted in a recent "Top 200" prescription list published by Verispan, a commercial firm. Results: Of this cohort of 3,290 women beginning pregnancy care in a one-year time span, this EMR query indicated that 394 (12.0%) had a behavioral health need; 5.2% were prescribed a medication alone, 3.1% had a diagnosis alone, and 3.6% had both. This is likely an underestimate, but the efficient EMR method serves as a helpful starting place for determining behavioral health needs to be addressed. Conclusions: These data indicate that screening for these conditions will likely yield modest, but steady, numbers of patients with behavioral health needs that could be integrated with obstetric care. Readily available data regarding most common diagnoses and most frequently prescribed drugs can be used to develop an initial estimate of the burden of behavioral health need in obstetrics. Other primary care settings could readily replicate this approach as an initial step for addressing behavioral health burden in primary care.