Barriers to Screening for Domestic Violence

Authors

  • Lorrie Elliott MD,

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  • Michael Nerney BA,

    1. Received from the Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, (LE), Chicago, Ill; Chicago College of Osteopathic Medicine, Midwestern University (MN), Downers Grove, Ill; the Department of Ophthalmology, Louisiana State University (TJ), New Orleans, La; and the Division of General Internal Medicine, Department of Medicine, Rhode Island Hospital and Brown University School of Medicine (PDF), Providence, RI.
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  • Theresa Jones MD,

    1. Received from the Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, (LE), Chicago, Ill; Chicago College of Osteopathic Medicine, Midwestern University (MN), Downers Grove, Ill; the Department of Ophthalmology, Louisiana State University (TJ), New Orleans, La; and the Division of General Internal Medicine, Department of Medicine, Rhode Island Hospital and Brown University School of Medicine (PDF), Providence, RI.
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  • Peter D. Friedmann MD, MPH

    1. Received from the Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, (LE), Chicago, Ill; Chicago College of Osteopathic Medicine, Midwestern University (MN), Downers Grove, Ill; the Department of Ophthalmology, Louisiana State University (TJ), New Orleans, La; and the Division of General Internal Medicine, Department of Medicine, Rhode Island Hospital and Brown University School of Medicine (PDF), Providence, RI.
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Address correspondence and requests for reprints to Dr. Elliott: University of Chicago Medical Center, Section of General Internal Medicine, 5841 S. Maryland Ave., MC 3051, Chicago, IL 60637 (e-mail: lelliott@medicine.bsd.uchicago.edu).

Abstract

CONTEXT: Domestic violence has an estimated 30% lifetime prevalence among women, yet physicians detect as few as 1 in 20 victims of abuse.

OBJECTIVE: To identify factors associated with physicians' low screening rates for domestic violence and perceived barriers to screening.

DESIGN: Cross-sectional postal survey.

PARTICIPANTS: A national systematic sample of 2,400 physicians in 4 specialties likely to initially encounter abused women. The overall response rate was 53%.

MAIN OUTCOME MEASURE: Self-reported percentage of female patients screened for domestic violence; logistic models identified factors associated with screening less than 10%.

RESULTS: Respondent physicians screened a median of only 10% (interquartile range, 2 to 25) of female patients. Ten percent reported they never screen for domestic violence; only 6% screen all their patients. Higher screening rates were associated with obstetrics-gynecology specialty (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.31 to 0.78), female gender (OR, 0.51; CI, 0.35 to 0.73), estimated prevalence of domestic violence in the physician's practice (per 10%, OR, 0.72; CI, 0.65 to 0.80), domestic violence training in the last 12 months (OR, 0.46; CI, 0.29 to 0.74) or previously (OR, 0.54; CI, 0.34 to 0.85), and confidence in one's ability to recognize victims (per Likert-scale point, OR, 0.71; CI, 0.58 to 0.87). Lower screening rates were associated with emergency medicine specialty (OR, 1.72; CI, 1.13 to 2.63), agreement that patients would volunteer a history of abuse (per Likert-scale point, OR, 1.60; CI, 1.25 to 2.05), and forgetting to ask about domestic violence (OR, 1.69; CI, 1.42 to 2.02).

CONCLUSIONS: Physicians screen few female patients for domestic violence. Further study should address whether domestic violence training can correct misperceptions and improve physician self-confidence in caring for victims and whether the use of specific intervention strategies can enhance screening rates.

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