A Training Program to Improve Domestic Violence Identification and Management in Primary Care: Preliminary Results

Thompson, Robert S.; Meyer, Birgit; Smith-DiJulio, Kathleen; Caplow, Madlen P.; Maiuro, Roland D.; Thompson, Donovan J.; Sugg, Nancy; Rivara, Frederick P.

doi:10.1891/0886-6708.13.4.395

Cited by 36 publications

(23 citation statements)

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“…[25][26][27][28][29] In addition, having a system-wide approach for managing IPV victims with on-site or easily accessible IPV referrals, like the Kaiser system, improves IPV management by providers. 30 One site that was part of a network of clinics, discussed the ease of managing their patients with alcohol problems because they had an on-site alcohol counselor.…”

Section: Discussionmentioning

confidence: 99%

Intimate Partner Violence: What Are Physicians' Perceptions?

Zink¹,

Regan²,

Goldenhar³

et al. 2004

The Journal of the American Board of Family Medicine

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Background: Intimate partner violence (IPV) is common in primary care; 11% to 22% of women experienced physical abuse in the past year. Older women experience IPV as well, but it is often undetected. This study examined primary care providers' awareness about IPV in older women, including their screening practices and management.Methods: Interviews and focus groups were conducted with 44 primary care providers. Thematic analysis was used to identify common themes.Results: Providers fell along a continuum of thoroughness for identifying and managing IPV in older women, ranging from suboptimal to thorough identification of IPV and suboptimal to thorough management of the patient. In addition to the barriers commonly reported about IPV screening in younger women, providers described limited understanding of the diagnoses commonly associated with IPV, frustration with older women's unwillingness to disclose problems and ask for help, and limited community services that accommodate older women with IPV. Providers recommended that communities sponsor public awareness campaigns about IPV as a problem for all women and that aging and IPV agencies work together.Conclusions

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Section: Discussionmentioning

confidence: 99%

Intimate Partner Violence: What Are Physicians' Perceptions?

Zink¹,

Regan²,

Goldenhar³

et al. 2004

The Journal of the American Board of Family Medicine

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“…5,6 Unfortunately, despite the well-documented occurrence of IPV in health care settings, studies continue to show that practicing physicians are not well trained in recognizing and managing IPV. [7][8][9][10] There are published examples of effective IPV training programs for community practitioners, but these programs are often expensive, institutionally based workshops 11,12 that are unsuitable for reaching large numbers of physicians. Given its low distribution costs, Internet-based~online!…”

Section: Introductionmentioning

confidence: 99%

Promoting free online CME for intimate partner violence: What works at what cost?

Harris

Novalis-Marine²,

Amend³

et al. 2009

Journal of Continuing Education in the Health Professions

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Promoting online CME, even well-received free CME, to busy community physicians requires resources, in this case at least $75 per physician reached. The effective use of promotional resources needs to be considered when developing social marketing strategies to improve community physician practices. Organizations with an interest in promoting online training might consider the use of e-promotion techniques along with conventional promotion strategies.

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“…13,14 And MAs have successfully participated in other prevention programs, including mammography referral, 15 tobacco cessation, 16,17 and screening for domestic violence. 18 Recent proposals to transform primary care highlight the crucial importance of redefi ning practice roles to optimize teamwork and appropriate application of skills. 19,20 …”

Section: Pro Gr a M To Pro M Ot E He A Lt Hy Behav Ior Smentioning

confidence: 99%

A Medical Assistant-Based Program to Promote Healthy Behaviors in Primary Care

Ferrer¹,

Mody-Bailey²,

Jaén³

et al. 2009

The Annals of Family Medicine

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PURPOSE Most primary care patients have at least 1 major behavioral risk: smoking, risky drinking, low physical activity, or unhealthy diet. We studied the effectiveness of a medical assistant-based program to identify and refer patients with risk behaviors to appropriate interventions. METHODSWe undertook a randomized control trial in a practice-based research network. The trial included 864 adult patients from 6 primary care practices. Medical assistants screened patients for 4 risk behaviors and applied behaviorspecifi c algorithms to link patients with interventions. Primary outcomes were improved risk behaviors on standardized assessments. Secondary outcomes included participation in a behavioral intervention and the program's effect on the medical assistants' workfl ow and job satisfaction.RESULTS Follow-up data were available for 55% of participants at a mean of 12 months. The medical assistant referral arm referred a greater proportion of patients than did usual care (67.4 vs 21.8%; P <.001) but did not achieve a higher success rate for improved behavioral outcomes (21.7 vs 16.9%; P = 0.19). Qualitative interviews found both individual medical assistant and organizational effects on program adoption.CONCLUSION Engaging more primary care team members to address risk behaviors improved referral rates. More extensive medical assistant training, changes in practice culture, and sustained behavioral interventions will be necessary to improve risk behavior outcomes. INTRODUCTIONS moking, risky drinking, physical inactivity, and unhealthy diet are pervasive challenges to health across the world. 1,2 With its high population contact rate, 3,4 primary care is well-positioned to address unhealthy behaviors, but its historical development as a physician-centered acute care delivery system has hampered its ability to manage the large burden of unhealthy behaviors and the chronic diseases that follow. 5 Most practices confront behavioral risks with a very limited response set-physician assessment and management-creating a bottleneck limited by the fl ow of physician workload. 6,7 Better outcomes call for a model of primary care that manages population risk at the necessary scale. 8 Such management requires engaging other members of the primary care team and forging linkages with community resources that can amplify the practice's impact. 9 A framework for managing behavioral risks in primary care emerges from the concept of multiscale complexity. 10 Organizations that address complicated problems must perform an array of tasks that vary in complexity and scale. Complexity measures the degree to which tasks require independent judgment and customization to produce a good outcome. Scale quantifi es the number of tasks to be performed. An important principle in optimizing effi ciency, therefore, is to correctly design a system that can respond to its environment with both low-variety and low-complexity tasks delivered on a 505 PRO GR A M TO PRO M OT E HE A LT HY BEHAV IOR Slarge scale, and high-variety and hig...

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A Training Program to Improve Domestic Violence Identification and Management in Primary Care: Preliminary Results

Cited by 36 publications

References 0 publications

Intimate Partner Violence: What Are Physicians' Perceptions?

Intimate Partner Violence: What Are Physicians' Perceptions?

Promoting free online CME for intimate partner violence: What works at what cost?

A Medical Assistant-Based Program to Promote Healthy Behaviors in Primary Care

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