# Knowledge and Confidence in Psychotropic Prescribing, Utilisation of Guidelines and Resources in Managing Perinatal Mental Health in General Practice: An Australian Cross‐Sectional Survey

## TL;DR

Australian GPs are generally confident in prescribing psychotropic medications during pregnancy, but confidence drops with complexity and rural GPs face challenges in accessing specialist support.

## Contribution

This study provides new insights into GPs' knowledge, confidence, and use of guidelines for psychotropic prescribing in perinatal mental health in Australia.

## Key findings

- 83% of GPs were confident in psychotropic prescribing, though confidence decreased with medication complexity.
- Rural GPs showed higher prescribing confidence but had less access to specialist perinatal psychiatry support.
- Only 37% of GPs were aware of national perinatal mental health guidelines, indicating a gap in awareness and usefulness.

## Abstract

Management of psychiatric disorders in the perinatal period is a common presentation in primary care. There is a need to understand how general practitioners (GPs) use guidelines and resources and incorporate the knowledge within clinical practice. This study aims to explore Australian GPs' knowledge and confidence in psychotropic prescribing in all stages of pregnancy in accordance with current guideline recommendations.

Cross‐sectional anonymous online survey.

National GP survey was undertaken.

132 GPs responded, 84% female, with 41% rural and 59% in metropolitan practice. Main Outcome Measure: exploring knowledge and confidence in psychotropic prescribing, vignettes of a range of clinical scenarios following recommended guidelines, and resource use and screening practices. Exploratory analysis using nonparametric tests occurred between sub‐groups within the data, including zones of practice and GP experience.

Overall, 83% were confident in psychotropic prescribing, a percentage that decreases with more complex and specialised psychotropic medication usage. Rural GPs had higher levels of prescribing knowledge and confidence across scenarios; however, they ranked accessing support from perinatal and general psychiatry lower in treatment choices. Years of experience were not significant. All GPs were aware of clinical prescribing guidelines, with up to 95% having used them. This was less so, with only 37% aware of Australian national perinatal mental health guidelines.

GPs have considerable knowledge and confidence and follow best practice recommendations in prescribing common psychotropic medications. The more complex the mental health requirements, the reduced level of confidence and need for greater specialist support. Differences in rural practice locations were observed and could be better served with streamlined support and referral pathways to specialist perinatal mental health advice. Clinical pharmacological practice guidelines were used; however, lack of awareness and usefulness of national guidelines on perinatal mental health could be improved by more specific guidance targeted to a GP population.

Perinatal mental health contributes to disease burden affecting 1 in 4 pregnancies which are mostly managed in general practice settingsMost studies focus on perinatal depression rather than more broadly understanding perinatal mental healthGuidelines exist nationally, but GPs awareness and use of these is unknown.

Perinatal mental health contributes to disease burden affecting 1 in 4 pregnancies which are mostly managed in general practice settings

Most studies focus on perinatal depression rather than more broadly understanding perinatal mental health

Guidelines exist nationally, but GPs awareness and use of these is unknown.

GPs overall confidence and knowledge in managing perinatal mental health are high, reducing with increasing complexity, and is mostly consistent with best practice recommendationsRural GPs appear to have more confidence overall and with increased complex scenarios, however the disparity in services across the nation potentially reflected how GPs managed prescribing psychotropic medications, with GPs in metropolitan settings more likely to seek advice from perinatal psychiatrists and treating psychiatristsAll participants were aware of therapeutic guidelines that they used regularly in their practice, and websites that were related to prescribing information. However, they were less familiar with more overarching Australian perinatal mental health guidelines and found these less useful

GPs overall confidence and knowledge in managing perinatal mental health are high, reducing with increasing complexity, and is mostly consistent with best practice recommendations

Rural GPs appear to have more confidence overall and with increased complex scenarios, however the disparity in services across the nation potentially reflected how GPs managed prescribing psychotropic medications, with GPs in metropolitan settings more likely to seek advice from perinatal psychiatrists and treating psychiatrists

All participants were aware of therapeutic guidelines that they used regularly in their practice, and websites that were related to prescribing information. However, they were less familiar with more overarching Australian perinatal mental health guidelines and found these less useful