Academic Unit of Primary Health Care, University of Bristol, 25-27 Belgrave Road, Clifton, Bristol, BS8 2AA, UK.
BMC Public Health. 2010 Feb 2;10:54. doi: 10.1186/1471-2458-10-54.
Domestic violence, which may be psychological, physical, sexual, financial or emotional, is a major public health problem due to the long-term health consequences for women who have experienced it and for their children who witness it. In populations of women attending general practice, the prevalence of physical or sexual abuse in the past year from a partner or ex-partner ranges from 6 to 23%, and lifetime prevalence from 21 to 55%. Domestic violence is particularly important in general practice because women have many contacts with primary care clinicians and because women experiencing abuse identify doctors and nurses as professionals from whom they would like to get support. Yet health professionals rarely ask about domestic violence and have little or no training in how to respond to disclosure of abuse.
METHODS/DESIGN: This protocol describes IRIS, a pragmatic cluster randomised controlled trial with the general practice as unit of randomisation. Our trial tests the effectiveness and cost-effectiveness of a training and support programme targeted at general practice teams. The primary outcome is referral of women to specialist domestic violence agencies. Forty-eight practices in two UK cities (Bristol and London) are randomly allocated, using minimisation, into intervention and control groups. The intervention, based on an adult learning model in an educational outreach framework, has been designed to address barriers to asking women about domestic violence and to encourage appropriate responses to disclosure and referral to specialist domestic violence agencies. Multidisciplinary training sessions are held with clinicians and administrative staff in each of the intervention practices, with periodic feedback of identification and referral data to practice teams. Intervention practices have a prompt to ask about abuse integrated in the electronic medical record system. Other components of the intervention include an IRIS champion in each practice and a direct referral pathway to a named domestic violence advocate.
This is the first European randomised controlled trial of an intervention to improve the health care response to domestic violence. The findings will have the potential to inform training and service provision.
ISRCTN74012786.
家庭暴力包括心理、身体、性、经济或情感方面的暴力，是一个严重的公共卫生问题，因为经历过家庭暴力的女性及其目睹家庭暴力的子女会长期受到健康影响。在普通科门诊就诊的女性人群中，过去一年中来自伴侣或前伴侣的身体或性虐待的发生率为 6%至 23%，终身发生率为 21%至 55%。家庭暴力在普通科中尤为重要，因为女性与初级保健临床医生有很多接触，而且遭受虐待的女性认为医生和护士是她们希望获得支持的专业人士。然而，卫生专业人员很少询问家庭暴力问题，也几乎没有接受过如何回应虐待行为披露的培训。
方法/设计：本方案描述了 IRIS，这是一项具有普通科实践单位随机分组的实用群组随机对照试验。我们的试验测试了针对普通科团队的培训和支持计划的有效性和成本效益。主要结局是将女性转介到专门的家庭暴力机构。英国两个城市（布里斯托和伦敦）的 48 个实践单位使用最小化方法随机分配到干预组和对照组。干预措施基于成人学习模型和教育外展框架，旨在解决询问女性家庭暴力问题的障碍，并鼓励对披露和转介到专门的家庭暴力机构做出适当回应。对干预组的临床医生和行政人员进行多学科培训课程，并定期向实践团队反馈识别和转介数据。干预组的实践单位在电子病历系统中设置了一个询问虐待的提示。干预措施的其他组成部分包括每个实践单位的 IRIS 冠军和直接转介途径到指定的家庭暴力倡导者。
这是第一项针对改善家庭暴力医疗保健反应的干预措施的欧洲随机对照试验。研究结果有可能为培训和服务提供提供信息。
ISRCTN74012786。
