Provider Readiness to Screen and Respond to Intimate Partner Violence Among Adult Patients in a Multi-Specialty Clinic Setting

Background:  Approximately 1 in 4 females and 1 in 10 males in the U.S. have experienced physical violence, sexual violence, or stalking by an intimate partner. Intimate partner violence (IPV) is associated with substantial physical and mental health consequences, high medical care costs and high rates of health service utilization. Health care providers who screen and counsel patients for IPV can reduce subsequent victimization and positively impact a patient’s well-being. However, only 2%-50% of medical professionals routinely screen female patients. A lack of knowledge about IPV and a low comfort level with addressing disclosures of victimization can hamper screening efforts. The purpose of this study was to obtain information about health care providers’ preparation, knowledge, and practices around IPV.

Methods: Data on preparation, knowledge, and practices around IPV were assessed using a modified version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS). Responses to items were assessed via a 7-point agreement scale or true/false/don't know options. Data were collected through an anonymous online survey in 2016. The survey was sent out to a random sample of 402 clinic providers who held various roles within a multi-specialty adult outpatient setting.  The final sample of respondents consisted of 217 health care providers (75.6% female; mean age = 44.2 years), including physicians (n=75), nursing staff (n=114), and social and behavioral health providers (n=28).

Results:  With respect to identifying, responding, and referring for IPV (possible range = 9-63, with higher scores indicating greater preparation), physicians (M = 24.6) and nursing staff (M = 26.0) reported being significantly less prepared than social/behavioral health providers (M= 44.9), and similar patterns held for fulfilling state reporting requirements for IPV, elder abuse and child abuse. Accurate knowledge of IPV among physicians and nursing staff (number of correct responses were 5.6 and 5.4 out of 12, respectively) was lower compared to social/behavioral health providers (7.6). Over half of respondents (52.1%) did not know whether their clinic had a protocol for dealing with adult IPV and 40.6% of respondents did not know whether there were adequate adult IPV referral resources for patients at their clinic. However, 37.3% of respondents indicated their clinic encouraged them to respond to IPV, 29.5% had adequate time to respond to victims of IPV, and 43.3% had adequate private space to safely screen for IPV.

Implications:  No provider type was especially well-prepared to screen and respond to adult patients who experienced IPV. The degree of knowledge and preparation was highest among social/behavioral health providers and levels were lower than anticipated for nursing staff. The findings highlight across-the-board training needs, in addition to differences in needs by provider type. Training gaps are similar to those found in extant literature and continue to signal the need for greater attention to such issues in medical training and greater support for interdisciplinary training.