Screening for Intimate Partner Violence in Health Care Settings<subtitle>A Randomized Trial</subtitle>

Abstract

EW ISSUES IN THE FIELD OF FAM-ily violence generate as much controversy as screening women for intimate partner violence (IPV) in health care settings. 1,2 Herein, we use the term screening to refer to universal routine inquiry: "a standardized assessment of patients, regardless of their reasons for seeking medical attention," 1 aimed at identifying women who are experiencing or have recently experienced IPV.Proponents of screening emphasize the following as a rationale for its implementation: the high prevalence of IPV and associated impairment, 3,4 the high level of acceptability among women about such inquiry, 5,6 the availability of feasible screening techniques, 7,8 and the opportunity to offer support and refer-rals to patients once IPV is identified. 6,9 Organizations such as the US Preventive Services Task Force 10 and the Canadian Task Force on Preventive Health Care 11 have concluded that insufficient evidence exists to recom-For editorial comment see p 568.

Using a Delphi Method to Develop Competencies: The Case of Domestic Violence

“…Although some years have passed since we first developed the competencies on DV for health care professionals, and while a number of studies have addressed DV in a variety of health care settings (for example, Kapur & Windish [31] MacMillan et al [15], D'Avolio [32], and Clements, et al [33]), there have been only modest gains made in applying competency based education to this topic in the ED environment. An American organization dedicated to promoting health professional education and research, the Academy on Violence and Abuse (AVA), has recently published (2011) Competencies Needed by Health Professionals for Addressing Exposure to Violence and Abuse in Patient Care.…”

“…Yet, despite this significant body of research, the prevalence of the issue among patient populations, its serious health consequences, and the acknowledged need for training by numerous medical organizations (including the American Medical Association, American Academy of Pediatrics, the Family Violence Prevention Fund, the Canadian Public Health Association, Canadian Psychiatric Association, Canadian Nurses Association, the Society of Obstetricians and Gynecologists of Canada) little headway has been made in developing a core curriculum for health care providers and physicians, particularly those in ED settings [14][15]. The need to educate health care professionals on identification and management of domestic violence is compelling.…”

Taking a Fresh Look at Routine Screening for Intimate Partner Violence: What Can We Do About What We Know?

“…However, recent evidence from several randomized clinical trials and new developments in the use of health information technology (HIT) have the potential to dramatically shift the balance in favor of routine IPV screening. Moreover, changes in the financing and restructuring of the way clinical care is provided and quality is measured are shifting the scope of health care system responsibility and opening up new opportunities for routine IPV screening in health care settings in ways that do not take physician time.Before the 2009 study conducted by MacMillan et al, 27 there were no large randomized controlled trials addressing the impact of IPV screening in health care settings. The MacMillan trial recruited 6743 women, aged 18 to 64 years, from 26 emergency departments and primary care sites.…”

“…Before the 2009 study conducted by MacMillan et al, 27 there were no large randomized controlled trials addressing the impact of IPV screening in health care settings. The MacMillan trial recruited 6743 women, aged 18 to 64 years, from 26 emergency departments and primary care sites.…”

“…The significant investment made by the Canadian government to conduct this study resulted in the key finding that there was no evidence of harm related to screening. 27 I would contend that the main finding of the MacMillan trial was that there is no support for physician intervention, since that was the only real difference between the groups. In contrast, the MacMillan study does offer observational support for the positive impact of systematic IPV screening and referral since all women in the trial were screened, and for ethical reasons, all abused women received referrals.…”