Small changes may help increase identification of domestic violence

October 29, 2000

Relatively simple, inexpensive changes at the doctor's office could help uncover and treat more cases of domestic violence, suggest the results of a study.

"We are on the verge of breakthroughs for this very important societal, cultural, legal, public health, and clinical problem," said lead author Robert S. Thompson, MD, director of the Department of Preventive Care at the Group Health Cooperative of Puget Sound, in Seattle, Wash.

Domestic violence affects up to 16 percent of U.S. couples every year, but primary care diagnosis of domestic violence is low, and treatment tends to be inadequate, according to the study.

Thompson and colleagues tested a systematic strategy over time to improve primary care of domestic violence victims. Previous researchers have cited physicians' fear of offending their patients, sense of futility, and their lack of training and time as "barriers to action" in domestic violence cases, according to the study.

At two primary care clinics, complete clinical teams (physicians, nurses, physician assistants, medical assistants, and receptionists) learned about domestic violence resources within Group Health and in the community. In addition, they received skills training in areas such as asking about domestic violence in high-risk situations and the use of a general questionnaire with two questions on domestic violence. Clinicians also received informative cue cards. Domestic violence posters and brochures were placed in waiting areas and restrooms. The program was reinforced by a newsletter and additional informal training sessions at the clinic sites by opinion leaders chosen for this role from the physician and nursing staffs.

Twenty-one months later, compared to clinicians who had received no training, those with training viewed themselves as more effective at addressing domestic violence -- they had strategies to help domestic violence victims and had access to information. Also, they were less afraid of offending patients and had fewer concerns regarding their own or patient safety from batterers.

According to patient records, inquiries about domestic violence increased by approximately 14 percent after the skills training sessions, largely because of the two domestic violence screening questions that were added to the physical exam. The researchers also noted a 30 percent increase (27 cases to 37 cases) in the diagnosis of domestic violence, although this was not statistically significant.

"Despite the modesty of the findings, system changes appear to be a cost-effective method to increase domestic violence identification," Thompson noted. The study results are published in the November 2000 issue of the American Journal of Preventive Medicine.

"We believe the findings from our study should translate into use of screening questions on health questionnaires, placement of posters and brochures in patient care areas, and provision of support services for providers and assistance to patients," said Thompson.

"Such factors are relatively easy to initiate and are proven to increase inquiries about domestic violence," Thompson concluded.
This research was funded by the Agency for Health Care Policy & Research, and The Group Health Foundation.

The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge, and wisdom in prevention science, education, practice, and policy. For more information about the Journal, contact the editorial office at (619) 594-7344.

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