By Will Boggs MD
(Reuters Health) – Women of reproductive age should be screened for intimate partner violence by their doctors, and physicians should help those who screen positive to get ongoing support services, according to updated recommendations from the U.S. Preventive Services Task Force (USPSTF).
“Intimate partner violence (IPV) can have devastating consequences to one’s health and wellbeing, and people experiencing IPV often do not tell others about it and do not ask for help,” said Dr. John W. Epling, Jr., a task force member from Virginia Tech Carilion School of Medicine in Roanoke.
“Doctors can make a real difference for women suffering from IPV by helping identify them and getting them the support they need through the use of various screening tools,” he told Reuters Health by email.
The USPSTF is an independent, government-supported panel of experts that reviews existing research to determine if medical practices and treatments are evidence-based. The final recommendation on partner violence, along with a report on the evidence of benefits and harms of screening, were published in JAMA.
The updated recommendation incorporates more recent research since the 2013 USPSTF recommendation on this topic, but the conclusion remains the same: there’s fairly good evidence of a moderate to substantial benefit, and clinicians should screen for IPV in women of reproductive age who don’t have signs and symptoms of abuse.
“If a doctor finds that a woman is experiencing IPV, it is important to arrange for ongoing support services for her,” Epling said. “These services can include things like counseling, home visitation and social-work assistance.”
While the task force found there are effective questions and tools doctors can use to screen women of reproductive age, they did not find evidence for the effectiveness of such tools to identify abuse of older or vulnerable adults without recognized signs and symptoms of abuse.
“Therefore, the Task Force is calling for more research to help inform what works in screening for these populations,” Epling said. “Doctors should use their best judgment when deciding who should be screened.”
“Physicians (or healthcare systems) who plan to implement an IPV-screening program should choose a validated screening tool that has good accuracy. Informally asking about abuse, or use of a tool that hasn’t been validated, is unlikely to identify women who will benefit from additional services,” said Dr. Cynthia Feltner from RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, who co-authored the evidence report.
“Routine screening is important for at least two reasons,” said Dr. Tami Sullivan from Yale University, in New Haven, Connecticut. “The first is that patients may feel more comfortable disclosing over time rather than at the time of the first screening, and they may need a prompt each time to consider the opportunity to disclose. The second is that patients’ relationships change over time and what could have been a non-aggressive relationship at the time of the last visit easily could have changed,” said Sullivan, who wasn’t involved in the recommendations.
“In addition to using the screening measures suggested by the USPSTF, clinicians should consider integrating a focus on patients’ relationships into the questions they regularly ask so that it becomes clear to patients that their relationships can impact their health, and further, that such a conversation is a normal part of their relationships with health care providers,” Sullivan told Reuters Health by email.
“Clinicians need to be aware of the ongoing services in the area so that they can refer the patient, but clinicians also need to know how to respond in the moment when the actual disclosure of victimization is made to reduce the likelihood of the potential harms to the patient,” Sullivan added.
“Physicians have to prioritize effectively screening their patients. However, screening for intimate partner violence is not sufficient; it must be coupled with clear interventions for patients who screen positive,” said Dr. Susie DiVietro from Connecticut Children’s Medical Center, in Hartford, who has studied IPV screening in settings from hair salons to trauma centers.
“There are limits to the screening model, which is why many organizations are moving toward a universal education model, where a patient receives information about intimate partner violence and its impact on health prior to any screening questions,” said DiVietro, who also was not involved in the recommendations. “The universal education model assures that each patient receives important referral information, so connection to resources does not hinge on the patient disclosing their abuse. ”
SOURCE: https://bit.ly/2PSYfmU, https://bit.ly/2yVi71q and https://bit.ly/2Ap2gu1 JAMA, online October 23, 2018.