PRISM implementation support increased depression care pathway adoption in obstetric practices compared to standard care.

This cluster randomized controlled trial involved 294 perinatal individuals with elevated depression symptoms enrolled across ten obstetric practices. Participants were assigned to receive either PRISM, consisting of MCPAP for Moms plus practice-level implementation support, or standard MCPAP for Moms alone. The primary objective was to assess the implementation of a depression care pathway, while secondary outcomes included screening for bipolar disorder, treatment engagement, follow-up monitoring, transition of care plans, identification of perinatal depression, and practice leadership capacity.

Results indicated that the PRISM intervention was associated with a substantially higher likelihood of screening for bipolar disorder (OR = 385.0; p = .001) and identifying individuals as having perinatal depression (OR = 2.3; p = .001) compared to the comparator. Treatment engagement was more likely in the intervention group (OR = 2.8; p = .011), as was follow-up monitoring (OR = 4.0; p = .003) and the creation of a transition of care plan (OR = 2.7; p = .016). Additionally, practice leadership surveys reported a greater increase in capacity to address perinatal depression (3.7 points; p = .005) among practices utilizing the implementation support.

No adverse events, serious adverse events, discontinuations, or tolerability issues were reported. The study design as a cluster randomized controlled trial supports causal inference regarding implementation metrics. However, the study did not report clinical outcomes such as symptom reduction or remission rates. The absence of reported safety data limits the ability to assess the tolerability of the intervention components in this specific context.

Key limitations include the lack of reported adverse events and the focus on implementation metrics rather than direct patient clinical outcomes. Practice-level assistance appears necessary to successfully implement new initiatives aligned with the depression care pathway. Clinicians should consider the potential for practice support to enhance care delivery structures, while awaiting data on patient-centered clinical benefits.