The majority of physicians receive no training regarding domestic abuse, cannot distinguish those experiencing violence, and are unsure about management after disclosure. The investigation involved general practices from two urban areas in the UK - Hackney (London) and Bristol. Two 2-hour multidisciplinary training sessions were included in the intervention program, which also included a prompt within the medical record for the GP to ask the women about abuse, and if the women wanted, a pathway to a named domestic violence advocate. Domestic violence advocacy includes provision of legal, financial and safety planning advice, housing, as well as helping giving women access to community resources, such as, emergency housing, refuges or shelters, and therapy. The advocacy organizations Next link in Bristol and the nia project in Hackney worked together to provide the training and additional consultancy.
Out of the 84 eligible general practices in Bristol and Hackney, 51 (61%) were randomly assigned to two groups. 24 general practices received a training and support program, while 24 received no training, before the trial had begun three general practices dropped out. One year after the second training session, the documented referral rate for the group that received training was 22 times higher (223 referrals) compared to group who did not receive training (12 referrals), even though this improvement is from a low baseline. In addition the group that received training also documented around three times the number of women disclosing domestic abuse (641) compared to the control group (236). In the investigation no adverse events were documented.
The researchers explain:
"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-victimization and improve quality of life and possibly mental health outcomes. 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."
"Worldwide, clinicians within primary care and other health-care settings are not responding adequately to domestic violence. In this study, we show the effectiveness of a brief intervention of training and support with a simple referral pathway to domestic violence advocacy."
Professor Feder states:
"The IRIS trial shows it is possible to link health services to domestic violence organizations at a time when these organizations, where they exist, are being cut or closed down. They are crucial for supporting women experiencing domestic violence."
In a joint comment Dr Kelsey Hegarty, General Practice and Primary Health Care Academic Centre, University of Melbourne, Australia; and Dr Paul Glasziou, Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia, explain:
"Overall, this is a very well designed and implemented trial of an educational and systems intervention, applicable to the UK setting. Did the intervention make a difference to the health and wellbeing of abused women? As the authors acknowledge, the main issue is the low rate of referrals and disclosures at baseline...Is this result clinically significant? Is 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."
"The results here are analogous to a promising phase 2 trial of cancerchemotherapy. Some might wish to fully implement the intervention now. Others would ask for further assessment."
Written by Grace Rattue