Barriers to screening for domestic violence.
BACKGROUND
Domestic violence has an estimated 30% lifetime prevalence among women, yet physicians detect as few as 1 in 20 victims of abuse.


OBJECTIVE
To identify factors associated with physicians' low screening rates for domestic violence and perceived barriers to screening.


METHODS
Cross-sectional postal survey.


METHODS
A national systematic sample of 2,400 physicians in 4 specialties likely to initially encounter abused women. The overall response rate was 53%.


METHODS
Self-reported percentage of female patients screened for domestic violence; logistic models identified factors associated with screening less than 10%.


RESULTS
Respondent physicians screened a median of only 10% (interquartile range, 2 to 25) of female patients. Ten percent reported they never screen for domestic violence; only 6% screen all their patients. Higher screening rates were associated with obstetrics-gynecology specialty (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.31 to 0.78), female gender (OR, 0.51; CI, 0.35 to 0.73), estimated prevalence of domestic violence in the physician's practice (per 10%, OR, 0.72; CI, 0.65 to 0.80), domestic violence training in the last 12 months (OR, 0.46; CI, 0.29 to 0.74) or previously (OR, 0.54; CI, 0.34 to 0.85), and confidence in one's ability to recognize victims (per Likert-scale point, OR, 0.71; CI, 0.58 to 0.87). Lower screening rates were associated with emergency medicine specialty (OR, 1.72; CI, 1.13 to 2.63), agreement that patients would volunteer a history of abuse (per Likert-scale point, OR, 1.60; CI, 1.25 to 2.05), and forgetting to ask about domestic violence (OR, 1.69; CI, 1.42 to 2.02).


CONCLUSIONS
Physicians screen few female patients for domestic violence. Further study should address whether domestic violence training can correct misperceptions and improve physician self-confidence in caring for victims and whether the use of specific intervention strategies can enhance screening rates.
Elliott
Lorrie
L
Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave., MC 3051, Chicago, IL 60637, USA. lelliott@medicine.bsd.uchicago.edu
Nerney
Michael
M
Jones
Theresa
T
Friedmann
Peter D
PD
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003625:Data Collection; D017579:Domestic Violence / Q000517:prevention & control* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D019221:Mandatory Reporting; D008403:Mass Screening / Q000592:standards / Q000639:trends*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D014481:United States / Q000453:epidemiology