Citation

Rhodes KV, Drum M, Anliker E, Frankel RM, Howes DS, Levinson W. Arch. Intern. Med. 2006; 166(10): 1107-1114.

Affiliation

Department of Medicine, Section of Emergency Medicine, University of Chicago, Ill, USA. rhodesk@uphs.upenn.edu

Copyright

(Copyright © 2006, American Medical Association)

DOI

10.1001/archinte.166.10.1107

PMID

16717173

Abstract

BACKGROUND: Women experiencing domestic violence (DV) frequent health care settings, but DV is rarely identified. METHODS: We conducted a randomized controlled trial to determine the effect of computer screening on health care provider-patient DV communication at 2 socioeconomically diverse emergency departments (EDs). Consenting nonemergent female patients, aged 18 to 65 years, were randomized to self-administered computer-based health risk assessment, with a prompt for the health care provider, or to "usual care"; all visits were audiotaped. Outcome measures were rates of DV discussion, disclosure, and services. RESULTS: Of 2169 eligible patients, 1281 (59%) consented; 871 (68%) were successfully audiotaped, and 903 (71%) completed an exit questionnaire. Rates of current DV risk on exit questionnaire were 26% in the urban ED and 21% in the suburban ED. In the urban ED, the computer prompt increased rates of DV discussion (147/262 56% vs 123/275 45%; P = .004), disclosure (37/262 14% vs 23/275 8%; P = .07), and services provided (21 8% vs 10 4%; P = .04). Women at the suburban site and those with private insurance or higher education were much less likely to be asked about experiences with abuse. Only 48% of encounters with a health care provider prompt regarding potential DV risk led to discussions. Both inquiries about and disclosures of abuse were associated with higher patient satisfaction with care. CONCLUSIONS: Computer screening for DV increased but did not guarantee that DV would be addressed during ED encounters. Nonetheless, it is likely that low-cost interventions that allow patients the opportunity to self-disclose can be used to improve detection of DV.

Language: en