Screening For Domestic Violence In Primary Care Practices
Screening For Domestic Violence In Primary Care Practices
Background: Interventions to change practice patterns among health care professionals have had mixed success. We tested the effectiveness of a practice centered intervention to increase screening for domestic violence in primary care practices.
Methods: A multifaceted intervention was conducted among primary care practice in North Carolina. All practices designated two individuals to serve as domestic violence resources persons, underwent initial training on screening for domestic violence, and participated in 3 lunch and learn sessions. Within this framework, practices selected the screening instrument, patient educational material, and content best suited for their environment. Effectiveness was evaluated using a pre/post cross-sectional telephone survey of a random selection of female patients from each practice.
Results: Seventeen practices were recruited and fifteen completed the study. Baseline screening for domestic violence was 16% with a range of 2% to 49%. An absolute increase in screening of 10% was achieved (range of increase 0 to 22%). After controlling for clustering by practice and other patient characteristics, female patients were 79% more likely to have been screened after the intervention (OR 1.79, 95% CI 1.43-2.23).
Conclusion: An intervention that allowed practices to tailor certain aspects to fit their needs increased screening for domestic violence. Further studies testing this technique using other outcomes are needed.
Domestic Violence (DV) or Intimate Partner Violence is the physical, sexual, or psychological harm to another by a current or former partner or spouse. Current estimates are that 5.3 million episodes of intimate partner victimization occur each year in the United States and nearly 25% of women have experienced some form of DV in their lifetime. DV is associated with poor health outcomes. Women with a history of DV have a 60% higher rate of physical health problems and are 4-6 times more likely to have depression.
Although the adverse health consequences of domestic violence have been widely documented, there is not consensus on the effectiveness of screening. While the United State Preventive Services Task Force recently found insufficient evidence to support routine screening for domestic violence, other physician organizations such as the American Medical Association, and the American College of Obstetricians and Gynecologists have stated support for inclusion of screening or awareness in medical practice. When surveyed, patients also support physicians inquiring about violence in the home. In concurrence with the practice organizations above and in support of patient findings, the Institute of Medicine published a report in 2001 calling for increased training of health care providers on family violence.
Interventions to increase screening for and awareness of domestic violence by health care professionals have had mixed success. Several studies have explored the barriers to routine screening. Lack of education and time, and fear of offending patients are frequently cited by health care providers as barriers to routine screening. An additional barrier that may contribute to the failure of a targeted program to increase screening is the inability of the intervention to adapt to the individual characteristics of the health care practice or professional. If the educational mode or tool to be tested is too rigid to integrate with a clinic's existing routines, it may be discarded or not adopted, resulting in a failure to change. We hypothesized that a practice-centered intervention that is sensitive to the particular needs of the practice while still remaining true to the underlying principles of quality may be more successful in implementing change. To determine if a practice-centered intervention could successfully change practice patterns, we conducted a multi-faceted intervention to increase screening for domestic violence.
Background: Interventions to change practice patterns among health care professionals have had mixed success. We tested the effectiveness of a practice centered intervention to increase screening for domestic violence in primary care practices.
Methods: A multifaceted intervention was conducted among primary care practice in North Carolina. All practices designated two individuals to serve as domestic violence resources persons, underwent initial training on screening for domestic violence, and participated in 3 lunch and learn sessions. Within this framework, practices selected the screening instrument, patient educational material, and content best suited for their environment. Effectiveness was evaluated using a pre/post cross-sectional telephone survey of a random selection of female patients from each practice.
Results: Seventeen practices were recruited and fifteen completed the study. Baseline screening for domestic violence was 16% with a range of 2% to 49%. An absolute increase in screening of 10% was achieved (range of increase 0 to 22%). After controlling for clustering by practice and other patient characteristics, female patients were 79% more likely to have been screened after the intervention (OR 1.79, 95% CI 1.43-2.23).
Conclusion: An intervention that allowed practices to tailor certain aspects to fit their needs increased screening for domestic violence. Further studies testing this technique using other outcomes are needed.
Domestic Violence (DV) or Intimate Partner Violence is the physical, sexual, or psychological harm to another by a current or former partner or spouse. Current estimates are that 5.3 million episodes of intimate partner victimization occur each year in the United States and nearly 25% of women have experienced some form of DV in their lifetime. DV is associated with poor health outcomes. Women with a history of DV have a 60% higher rate of physical health problems and are 4-6 times more likely to have depression.
Although the adverse health consequences of domestic violence have been widely documented, there is not consensus on the effectiveness of screening. While the United State Preventive Services Task Force recently found insufficient evidence to support routine screening for domestic violence, other physician organizations such as the American Medical Association, and the American College of Obstetricians and Gynecologists have stated support for inclusion of screening or awareness in medical practice. When surveyed, patients also support physicians inquiring about violence in the home. In concurrence with the practice organizations above and in support of patient findings, the Institute of Medicine published a report in 2001 calling for increased training of health care providers on family violence.
Interventions to increase screening for and awareness of domestic violence by health care professionals have had mixed success. Several studies have explored the barriers to routine screening. Lack of education and time, and fear of offending patients are frequently cited by health care providers as barriers to routine screening. An additional barrier that may contribute to the failure of a targeted program to increase screening is the inability of the intervention to adapt to the individual characteristics of the health care practice or professional. If the educational mode or tool to be tested is too rigid to integrate with a clinic's existing routines, it may be discarded or not adopted, resulting in a failure to change. We hypothesized that a practice-centered intervention that is sensitive to the particular needs of the practice while still remaining true to the underlying principles of quality may be more successful in implementing change. To determine if a practice-centered intervention could successfully change practice patterns, we conducted a multi-faceted intervention to increase screening for domestic violence.