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Domestic violence training for GP ups disclosure and referral rates

Recorded referral rate to advocacy services 22 times higher in urban practices

Caroline White

Thursday, 13 October 2011

GPs and practice nurses given specialist training in domestic violence are 22 times more likely to refer women to advocacy organisations, suggests research published online in The Lancet today. 

Most clinicians fail to identify patients who are being abused and don’t know how to manage them if they do find out, say the authors, who included 51 general practices out of a total of 84 from Bristol and Hackney, London, in their study.  

Of these, 24 received a training and support programme, which included two 2 hour multidisciplinary training sessions, a prompt within the medical record to ask about abuse, and a referral pathway to a named domestic violence advocate, if that was what the woman wanted.  

Domestic violence advocacy includes provision of legal, housing, financial and safety planning advice, and facilitation of access to community resources, such as refuges or shelters, emergency housing, and psychological support. The collaborating advocacy organisations (Next Link, Bristol and the nia project, Hackney) also delivered the training and further consultancy. 

Twenty four practices did not take part in the programme, and three dropped out before the trial started.  

A year after the second training session, the recorded referral rate in the intervention practices was 22 times higher than in the comparison group (223 referrals vs 12), although this improvement was from a low baseline. Intervention practices also recorded around three times the number of women disclosing domestic violence (641 vs 236).  

“The substantial difference in referrals is strong evidence that the intervention improves the response of clinicians to women experiencing domestic violence and enables access to domestic violence advocacy that can reduce re-victimisation and improve quality of life and possibly mental health outcomes,” write the authors.  

“Our findings reduce the uncertainty about the benefit of domestic violence training and support interventions in primary care settings, particularly outside North America, and show that screening is not a necessary condition for benefit,” they add.

“Worldwide, clinicians within primary care and other health-care settings are not responding adequately to domestic violence,” they say. 

Lead author Professor Gene Feder adds: “[This] trial shows it is possible to link health services to domestic violence organisations at a time when these organisations, where they exist, are being cut or closed down. They are crucial for supporting women experiencing domestic violence.”   

In a linked Comment, Dr Kelsey Hegarty, of the General Practice and Primary Health Care Academic Centre, University of Melbourne, and Dr Paul Glasziou, Centre for Research in Evidence-Based Practice, Bond University, Queensland, ask whether the result is clinically significant and whether the intervention a good investment of time and resources.  

“The evidence is certainly promising for advocacy, but whether the small increase of women referred for advocacy would translate into better outcomes for women is unknown,” they say. 

“The results here are analogous to a promising phase 2 trial of cancer chemotherapy. Some might wish to fully implement the intervention now. Others would ask for further assessment,” they conclude.

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