Access to health services by women subjected to violence: findings from administrative healthcare data from the metropolitan area of northern Italy

Abstract

Background: In Italy, approximately 50% of women report experiencing episodes of psychological and/or physical violence. The Emergency Department (ED) is widely recognized as one of the health services to which victims of violence seek treatment for injuries and within which situations of domestic violence and abuse can be recognized. This work aims to estimate the phenomenon of violence in the population of the Health Protection Agency (ATS) of Milan using data from emergency room access and hospital admissions. A further goal of the survey is to provide evidence to launch audit processes in health units designed to foster improvement strategies for the management of the phenomenon and guarantee integration with anti-violence centers. Methods: In the first phase of the project, an algorithm was designed to detect women subjected to violence intercepted in the five years 2019-2023 in the administrative healthcare data of emergency rooms and hospital admissions. To identify the cases, the specific diagnosis codes of the ICD-9 have been selected. Prevalence and time trends of the phenomenon were estimated, stratifying by different socioanagraphic characteristics and by types and attributes of access. In addition, the degree of integration between social and health services was analyzed. The areas researched concern intake by specialized services; specifically, data on female residents of the cohort were cross-referenced with data on access to the network of social health services in the ATS territory. Results: A clearly increasing phenomenon emerges: from 2019 to 2023, admissions to the ED have risen by 17%. A total of 35.6 percent of admissions involve women between the ages of 18 and 34. Foreigners account for approximately 40.9 percent of the cohort while constituting 15 percent of women residing in the territory. The yellow (Urgency) triage code is assigned for 3 out of the 4 admissions. A total of 11.5% of women had multiple accesses. Conclusions: Administrative healthcare data offer consistent data for studying the phenomenon of violence. This project aims to provide useful tools to better guide policies for intervention and integration between services in the area. Further reflection will focus on the possibility of integrating health and social services to support an intersectoral approach.