Abstract
BackgroundDomestic violence and abuse (DVA) and child safeguarding are interlinked problems, impacting on all family members. Documenting in electronic patient records (EPRs) is an important part of managing these families. Current evidence and guidance, however, treats DVA and child safeguarding separately. This does not reflect the complexity clinicians face when documenting both issues in one family.AimTo explore how and why general practice clinicians document DVA in families with children.Design and settingA qualitative interview study using vignettes with GPs and practice nurses (PNs) in England.MethodSemi-structured telephone interviews with 54 clinicians (42 GPs and 12 PNs) were conducted across six sites in England. Data were analysed thematically using a coding frame incorporating concepts from the literature and emerging themes.ResultsMost clinicians recognised DVA and its impact on child safeguarding, but struggled to work out the best way to document it. They described tensions among the different roles of the EPR: a legal document; providing continuity of care; information sharing to improve safety; and a patient-owned record. This led to strategies to hide information, so that it was only available to other clinicians.ConclusionManaging DVA in families with children is complex and challenging for general practice clinicians. National integrated guidance is urgently needed regarding how clinicians should manage the competing roles of the EPR, while maintaining safety of the whole family, especially in the context of online EPRs and patient access.
Highlights
The present study reports a nested qualitative study (RESPONDS: Researching Education to Strengthen Primary care ON Domestic violence and Safeguarding) of general practice clinicians’ response to Domestic violence and abuse (DVA), in
This study focused on interviewees’ responses about documenting as this illuminates the current organisational and attitudinal barriers faced by general practice clinicians managing DVA in families
Knowledge and attitudes regarding documentation Participants described various methods of documenting DVA and child safeguarding in the electronic patient records (EPRs) from national codes to freetext entries (Box 1)
Summary
Research and health policy conceptualises EPRs as a mechanism to improve health care through increased efficiency, influence professional behaviour, and empower patients through access to their records.[13,14,15] Documenting in EPRs is a key mechanism for information sharing in child safeguarding.[6,7] UK policy encourages health professionals to document child safeguarding concerns in all family members’ records, recognising the need for a whole-family approach.[7,16] This is supported by national guidance on the mechanism of documenting (including which codes to use) and reinforced through mandatory training for general practice clinicians.[16,17] there is increasing recognition of unintended consequences of EPRs and their impact on individual and organisational behaviour.[18,19,20] there are ongoing professional concerns about documenting stigmatising information, including DVA.[21] With DVA, confidentiality is essential given the risk of abuse escalation when a perpetrator discovers disclosure. This does not reflect the complexity clinicians face when documenting both issues in one family
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