(Philadelphia, PA) – Although victims of
domestic violence frequently seek out care in hospital emergency
departments, the abuse is rarely identified by department staff
and the issue is often not broached. Experts attribute this to clinicians
who are reluctant to discuss this sensitive topic, combined with
the time constraints faced by the staff.
Now, a new study indicates that the use of a simple and inexpensive
computer-based questionnaire increases the odds, but did not guarantee
that domestic violence would be addressed during emergency department
encounters. Results of the study are published in the May 22 issue
of Archives of Internal Medicine.
“Victims of domestic violence are often eager and willing
to talk about the issue with a healthcare provider but are reluctant
to bring it up first,” says Karin Rhodes, MD,
Emergency Medicine physician at the Hospital of the University
of Pennsylvania and lead author of the study.
“Previous studies indicate that patients are more likely
to disclose sensitive information, including experiences with domestic
violence, on computer-based screenings than on paper surveys or
in personal interviews,” she says.
To further test these findings, Rhodes and her colleagues set
up a computer screening program in two emergency departments, one
urban and one suburban. Over a 19-month period, 903 women were randomly
selected to either complete the computer-based risk assessment or
receive standard care.
The computer program asked questions about a variety of health
risks, including eight that addressed domestic violence. If a woman
responded positively to any of the eight questions, an alert advising
the physician to assess her for domestic violence appeared on a
printout that was then stapled to the patient’s chart.
Participants were audiotaped during their interactions with physicians
and completed an exit questionnaire. Researchers later reviewed
the tapes to determine if domestic violence was discussed, disclosed,
or treated during each encounter.
Of the women who completed the exit questionnaire, 26 percent at
the urban ED and 21 percent at the suburban ED indicated they were
at risk for domestic violence. Those who completed the computer
screening were more likely to talk to a physician or nurse practitioner
about domestic violence and twice as likely to disclose domestic
violence during the ED visit as those who received standard care.
In the urban ED, women who completed the computer survey were
more likely than those who received routine care to discuss domestic
violence with their clinician, disclose their own domestic violence
situations or receive care or referrals for domestic violence. Women
at the suburban site were much less likely to discuss or disclose
At both sites, only 48 percent of the women (17 percent in the
suburban ED and 61 percent in the urban ED) whose computer surveys
generated an alert for the physician had a discussion about domestic
violence during their visit.
“This shows how much reluctance there is among clinicians
to discuss this issue with patients,” says Rhodes. “Even
when a red flag went up on the computer screening, it still didn’t
guarantee that the clinician would discuss it with the patient.”
Although domestic violence is a highly prevalent condition, detection
in the ED remains elusive, the study authors conclude.
“Our current system provides no mechanism for women to reveal
domestic abuse,” says Rhodes. “We found that women will
disclose their domestic violence risk to a computer, however.
“Our study both supports the potential for computer screening
to increase identification and referral for domestic violence and
raises the concern that ED physicians, particularly suburban physicians,
may need additional training to adequately recognize and respond
to chronic, complex psychosocial issues.”
The study also found that when a clinician followed-up on a computer
prompt and discussed domestic violence with a patient, that patient’s
satisfaction with her visit increased.
Editor’s Note: This project was funded by
a grant from the Agency for Healthcare Research and Quality. Rhodes
is also supported by a grant from the National Institute of Mental
Health, Bethesda, Md.
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