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Doctors urged to screen women for domestic abuse

Asking standard questions of female patients of childbearing age shows a 'moderate net benefit' and little risk, a federal advisory panel says.

January 21, 2013|By Monte Morin, Los Angeles Times

Women of childbearing age should undergo screening for domestic violence and other forms of abuse while visiting their doctor or clinic, according to a recommendation published online Monday by an influential panel of medical experts that advises the federal government.

That recommendation, published in the Annals of Internal Medicine, marks a significant change from 2004 when the U.S. Preventive Services Task Force found insufficient evidence to support screenings for so-called intimate partner violence, or IPV.

Now, citing new evidence, the task force said that screening women for IPV with a list of standard questions showed a "moderate net benefit," while the risks associated with disclosing abuse were small.

If abuse is confirmed, physicians should provide patients with, or refer them to, intervention services, the panel said. Such services include counseling, home visits, information cards, community service referrals and mentor programs.

The guidelines apply only to women aged 14 to 46 who do not show obvious signs of physical or sexual abuse that would otherwise prompt questions from healthcare providers. Though the report acknowledged that women of childbearing age were not the only people who suffered abuse at the hands of former or current intimate partners, evidence was still insufficient to recommend broader screenings, the authors said.

"The bottom line is that more research is needed on how primary-care clinicians can effectively screen and protect all populations, including older and vulnerable adults, middle-aged women, men and children from abuse and violence," said Dr. David Grossman, a Seattle pediatrician and task force member.

In a separate draft statement addressing child maltreatment, task force members said there wasn't enough evidence to recommend how clinicians could prevent abuse among children who lacked obvious symptoms.

Intimate partner violence includes physical violence, sexual abuse, psychological abuse, stalking and reproductive coercion — intimidation that increases the risk of unplanned pregnancy. The Centers for Disease Control and Prevention estimates that nearly 31% of women and 26% of men have experienced IPV in their lifetimes. Immediate health consequences include injury, death, sexually transmitted diseases, unintended pregnancy, psychological distress and premature births.

Screening for domestic violence is recommended by the American Congress of Obstetricians and Gynecologists for women of all ages. Other organizations, such as the American Medical Assn., encourage physicians to inquire about abuse in all patients as part of medical history, but do not recommend a specific screening format or list of questions.

Monday's recommendation by the task force could possibly steer organizations toward adopting a more standardized protocol, according to some healthcare providers.

"This is very significant," said Eric Ferrero, a Planned Parenthood spokesman who was not involved in the study. "It's just good practice to know a patient's health history, and we have been conducting screenings for a number of years. Hopefully, with this recommendation, it will be done more broadly."

In the case of Planned Parenthood, which treats about 3 million patients in 800 facilities, IPV screenings were sometimes the first time that patients spoke of or even acknowledged abuse, Ferrero said. "We know, at least anecdotally, that this first discussion has led some women to leave an abusive relationship."

The task force recommendation was based on a review of dozens of studies and interviews with more than 30,000 people. Screenings were conducted several ways. Some women were questioned face to face by their healthcare provider and others performed self-screenings, answering questions on either a computer or a printed questionnaire.

monte.morin@latimes.com

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