A practice-centered intervention to increase screening for domestic violence in primary care practices.

Denise E Bonds,Shellie D Ellis,Shana L Palla,Peter Lichstein,Erin Weeks

doi:10.1186/1471-2296-7-63

Abstract

BackgroundInterventions 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.MethodsA 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.ResultsSeventeen 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).ConclusionAn 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.

Highlights

Interventions to change practice patterns among health care professionals have had mixed success
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 Domestic Violence (DV) in their lifetime [2]
Health care provider characteristics and clustering by practice were accounted for, patients were 79% more likely to have been screened after the intervention than at baseline

Summary

Introduction

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. Domestic Violence (DV) or Intimate Partner Violence is the physical, sexual, or psychological harm to another by a current or former partner or spouse [1]. While the United State Preventive Services Task Force recently found insufficient evidence to support routine screening for domestic violence [5], other physician organizations such as the American Medical Association [6], and the American College of Obstetricians and Gynecologists [7] have stated support for inclusion of screening or awareness in medical practice. 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 [11]

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Discussion

Conclusion