Screening and intervention for intimate partner abuse - Practices and attitudes of primary care physicians

Context Although practice guidelines encouraging the screening of patients for intimate partner abuse have been available for several years, it is unc lear how well and in which circumstances physicians adhere to them. Objective To describe the practices and perceptions of primary care physici ans regarding intimate partner abuse screening and interventions. Design, Setting, and Participants Cross-sectional survey of a stratified pr obability sample of 900 physicians practicing family medicine, general inte rnal medicine, and obstetrics/gynecology in California. After meeting exclu sion criteria, 582 were eligible for participation in the study. Main Outcome Measure Reported abuse screening practices in a variety of cli nic settings, based on a 24-item questionnaire, with responses compared by physician sex, practice setting, and intimate partner abuse training. Results Surveys were completed by 400 (69%) of the 582 eligible physicians, including 149 family physicians, 115 internists, and 136 obstetrician/gyne cologists. Data were weighted to estimate the practices of primary care phy sicians in California. An estimated majority (79%; 95% confidence interval [CI], 75%-83%) of these primary care physicians routinely screen injured pa tients for intimate partner abuse. However, estimated routine screening was less common for new patient visits (10%; 95% CI, 7%-13%), periodic checkup s (9%; 95% CI, 6%-12%), and prenatal care (11%; 95% CI, 7%-15%), Neither ph ysician sex nor recent intimate partner abuse training had significant effe cts on reported new patient screening practices. Obstetrician/gynecologists (17%) and physicians practicing in public clinic settings (37%) were more likely to screen new patients. Internists (6%) and physicians practicing in health maintenance organizations (1%) were least likely to screen new pati ents. Commonly reported routine interventions included relaying concern for safety (91%), referral to shelters (79%) and counseling (88%), and documen tation in the medical chart (89%). Commonly cited barriers to identificatio n and referral included the patients' fear of retaliation (82%) and police involvement (55%), lack of patient disclosure (78%) and follow-up (52%), an d cultural differences (56%). Conclusions These findings suggest that primary care physicians are missing opportunities to screen patients for intimate partner abuse in a variety o f clinical situations. Further studies are needed to identify effective int ervention strategies and improve adherence to intimate partner abuse practi ce guidelines.