Despite national guidelines recommending routine screening for anxiety and intimate partner violence in women and adolescent girls, a new study from Oregon Health & Science University finds these screenings are rarely implemented in primary care settings, largely due to lack of awareness, workflow challenges and provider discomfort.
The research involved interviews with 27 clinicians and staff across 12 clinics in Oregon. The findings, published in the Journal of the American Board of Family Medicine suggest that even though providers support the idea of screening, many are unaware that these services are recommended and fully covered under the preventive services mandate of the Affordable Care Act.
“This was really about taking the temperature of what's happening in primary care by understanding current screening practices,” said the study’s senior author Amy Cantor, M.D., M.P.H. , professor of medical informatics and clinical epidemiology, family medicine and obstetrics and gynecology in the OHSU School of Medicine.
“We found widespread support, but limited uptake. Most clinicians didn’t know these are covered preventive services. Some confused anxiety screening with depression screening, which are two separate recommendations with different tools.”
Official guidelines from the Women’s Preventive Services Initiative recommends screening for anxiety in adolescent and adult women, as well as for intimate partner and domestic violence. Fewer than half of the 12 clinics in Oregon screened for both.
Barriers identified in the study include “screening fatigue,” lack of clear referral pathways, and discomfort with discussing intimate partner violence. Many clinics also lacked standardized workflows and weren't sure how to document or follow up on positive screens.
“Primary care clinicians are overwhelmed with what they’re expected to screen for,” Cantor said. “The key is to integrate anxiety and intimate partner violence screening into existing systems and make it part of routine care.”
With intimate partner violence, providers cited privacy concerns and fears about handling sensitive disclosures without proper resources. Cantor said that normalizing the conversation — by asking every eligible patient in a consistent, supportive manner — can help reduce stigma since all patients may benefit from universal education and resources, regardless of their circumstances.
“Universal screening sends a message: This isn’t just about one type of patient,” she said. “The consequences of missing intimate partner violence or untreated anxiety can be significant downstream.”
As part of the study’s outcomes, the research team developed step-by-step clinical workflow guides for screening, documentation, referrals and even billing resources now available to clinicians. They relied on the partnership of the OHSU Oregon Rural Practice-Based Research Network to work with clinics in rural and school settings across Oregon.
“These are tangible tools clinicians can use tomorrow,” Cantor said. “We hope they will make it easier to do what the science already supports: identify problems early and help patients get the care they need.”
In addition to Cantor, OHSU co-authors include Chrystal Barnes, M.P.H. , Sonja Likumahuwa-Ackman, M.I.D., M.P.H. , Tamar Wyte-Lake, D.P.T., M.P.H. , Miranda Pappas, M.A. , and Keeley Blackie, C.P.H., M.P.H. , as well as Heidi Nelson, M.D., M.P.H., with the Kaiser Permanente Bernard J. Tyson School of Medicine.
This study was funded by a grant from the Health Resources and Services Administration (HRSA) through the Women’s Preventive Services Initiative (WPSI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.
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Barriers and Facilitators to Screening for Anxiety and Intimate Partner Violence
18-Feb-2026