Overcoming Barriers to Physician Involvement in Identifying and Referring Victims of Domestic Violence

Gremillion, David H.; Kanof, Elizabeth P

doi:10.1016/s0196-0644(96)70200-7

Cited by 69 publications

(40 citation statements)

References 24 publications

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“…Perhaps the low screening rate was due to the fact that 60% believe they didn't have enough time to handle the cases and 48% expressed frustration over the lack of 24-hour access to resources. 17 …”

Section: Muelleman Liewer Return Without Intimate Violence Injuriesmentioning

confidence: 99%

How Often Do Women in the Emergency Department without Intimate Violence Injuries Return with Such Injuries?

Muelleman

Liewer

1998

Academic Emergency Medicine

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A6stract. Objective: To determine the rate at which a group of women visiting the ED for reasons other than intimate violence return to the ED at a later time for intimate-violence-related injuries. Methods: Retrospective cohort study of a group of women with intimate-violence-related injuries on an index visit and a matched comparison group. Return visit rates to the ED for intimate violence injuries over the next 5 years were then compared. Results: The 95 women in each group were followed an average of 57 months. M the ED for reasons other than battering injuries. One ED-based study estimated that the incidence of acute (c1 month) domestic violence among women with a current male partner is 11.7%. Only about one fourth of these women presented for care because of trauma, and most did not have abuse documented in the medical record.' In other words, most women in violent relationships go to the ED for reasons other than acute injury and there is no documentation in the medical record of their abuse This realization h a s moved the concept of identifying violent relationships from asking only women with suspicious injuries, to asking all women. Many organizations have called for universal screening for intimate violence in all female p a t i e n t P ; however, the mechanism to do this in a busy ED, with limited available staff, has yet to be answered. Ideally, screening for any "disease" should be inexpensive, noninvasive, and safe. It should have a high sensitivity, but a low false-positive rate. Positive screens should result in a n intervention that improves outcomes.s If one goal of screening "asymptomatic" patients for violent relationships is to prevent further injury, it would be important to know whether "asymptomatic" women in the ED ever return to the ED for intimate-violence-related injuries. The purpose of this study was to determine t h e rate at which women visiting t h e E D for reasons other than intimate violence injury return to the ED at a later time with intimate violence injuries. METHODSStudy Design. This was a retrospective cohort study of women with intimate-violence-related injuries on an ED index visit a n d a matched comparison group. The study was approved by the Truman Medical Center (TMC)/University of Missouri-Kansas City (UMKC) institutional review board.Study Setting and Population. The study took place at TMC, a n inner-city county hospital that serves a s the primary teaching hospital for the UMKC School of Medicine. It currently has a patient volume of >45,000 visits of patients aged 1 1 5 years. There was no formal screening protocol for intimate violence in place during the active study period. Study Protocol. We first identified retrospectively all women aged 2 18 years diagnosed as having intimate-violence-related injuries between January 1, 1992, and J u n e 30, 1992. The women in this case group were identified by the presence of the ICD-9 code6 diagnosis of 995.81 (adult maltreatment syndrome) in one of 3 diagnostic code

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Section: Muelleman Liewer Return Without Intimate Violence Injuriesmentioning

confidence: 99%

How Often Do Women in the Emergency Department without Intimate Violence Injuries Return with Such Injuries?

Muelleman

Liewer

1998

Academic Emergency Medicine

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“…[12][13][14][15][16][17][18] Many barriers exist: lack of physician training and time, few local resources for victims, concerns for personal and patient safety, complexity of the problem, and personal discomfort and concern for patients' discomfort. 11,12,15,[19][20][21][22][23][24] Most physicians believe that abuse is not common in their practice 21,22,25 and that screening questions will damage the physician-patient relationship among patients who are not victims.…”

Section: Introductionmentioning

confidence: 99%

Patients' Advice to Physicians About Intervening in Family Conflict

Burge¹,

Schneider

Ivy

et al. 2005

The Annals of Family Medicine

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PURPOSE We wanted to understand patients' views about physician interventions with family violence and confl ict.METHODS Clinic staff surveyed 253 male and female family practice patients in 6 member offi ces of the South Texas Ambulatory Research Network (STARNet). The survey instrument addressed demographics, relationship quality, intimate partner violence, and physician interventions with family confl ict. Open-ended questions asked respondents to provide advice for "doctors who want to help patients with severe family problems." RESULTS Among women in relationships, 10% reported being physically hurt by a partner in the past year and 39% in their lifetimes. Among men in relationships, 7% reported physically hurting their partner in the past year and 16% in their lifetimes. Nearly all respondents, including 100% of victims and perpetrators of violence, believed physicians should ask about family confl ict (96%), and that physicians could be helpful (93%). Two thirds of the sample reported that their physician had never asked them about family confl ict. Investigators used qualitative analysis to summarize patients' advice to physicians. Responses clustered around 3 general themes: communication, assistance, and cautions or encouragement. Patients want physicians to ask about family confl ict, listen to their stories, and provide information and appropriate referrals. They raised some cautions and concerns, but also provided words of encouragement. CONCLUSIONMost patients are open to discussions about family confl ict with their physicians. The skills they recommend to physicians are well within the domain of family medicine training.

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“…This is due, in large part, to provider time constraints and reluctance to initiate discussions about partner violence. 11 Primary care settings, with increasingly abbreviated scheduled appointments, face similar obstacles. 12,13 Nonetheless, patients expect physicians to inquire and will usually disclose abuse if directly questioned.…”

Section: Introductionmentioning

confidence: 99%

“…19,20 Although the ED patient population is associated with high prevalence rates of IPV, 21 the ED setting presents formidable barriers to routine screening. 22,23 Recently, there has been increasing recognition of the value of EDs as potential sites for injury surveillance and violence prevention. [24][25][26] Practical methods for conducting IPV screening are needed to realize this potential.…”

Section: Introductionmentioning

confidence: 99%

“Between me and the computer”: Increased detection of intimate partner violence using a computer questionnaire

Rhodes

Lauderdale

et al. 2002

Annals of Emergency Medicine

195

166

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Overcoming Barriers to Physician Involvement in Identifying and Referring Victims of Domestic Violence

Cited by 69 publications

References 24 publications

How Often Do Women in the Emergency Department without Intimate Violence Injuries Return with Such Injuries?

How Often Do Women in the Emergency Department without Intimate Violence Injuries Return with Such Injuries?

Patients' Advice to Physicians About Intervening in Family Conflict

“Between me and the computer”: Increased detection of intimate partner violence using a computer questionnaire

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