From the Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA (OLA, JEB, ARG, KMI); Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA (OLA, JEB); Women's Health Center, VA Boston Healthcare System, Boston MA (MRG); Section of General Internal Medicine, Boston University School of Medicine, Boston, MA (MRG); VA Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, PA (MED); School of Social Work, Temple University, Philadelphia, PA (MED); Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC (ARG); VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA (ABH); Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA (ABH); Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, CA (SWS); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA (SWS); Department of Psychiatry, Boston University School of Medicine, Boston MA (KMI).
J Am Board Fam Med. 2021 Mar-Apr;34(2):346-356. doi: 10.3122/jabfm.2021.02.200311.
Evidence supports the clinical effectiveness of intimate partner violence (IPV) screening programs, but less is known about implementing and sustaining them. This qualitative study identified implementation strategies used to integrate IPV screening programs within Veterans Health Administration (VHA) women's health primary care.
Thirty-two administrators and clinician key informants from 11 VHA facilities participated in semistructured interviews. Implementation strategies were identified using established definitions from implementation science literature, through multistep content analysis, involving site comparisons by implementation status.
We identified 8 implementation strategies. Three were present across all sites: (1) conduct ongoing IPV trainings, (2) conduct educational meetings and outreach visits, and (3) develop and distribute educational materials. Five strategies were unique to early adopting sites: (4) identify and prepare champions, (5) change record systems to remind clinicians, (6) create a learning collaborative through advisory boards or workgroups, (7) audit and provide feedback with relay of clinical data to providers, and (8) access new funding.
Strategies align with and extend literature addressing barriers to screening. Evidence shows that effective IPV screening implementation in primary care requires a bundle of well-defined, carefully selected strategies.
Implementation strategies used collectively can enable integration of IPV screening programs in primary care.
有证据支持亲密伴侣暴力（IPV）筛查项目的临床有效性，但对于如何实施和维持这些项目知之甚少。这项定性研究确定了在退伍军人健康管理局（VHA）妇女保健初级保健中整合 IPV 筛查项目所使用的实施策略。
来自 11 个 VHA 设施的 32 名管理人员和临床医生关键信息员参加了半结构化访谈。通过多步骤的内容分析，使用实施科学文献中的既定定义，通过实施状态的站点比较，确定了实施策略。
我们确定了 8 种实施策略。有 3 种策略存在于所有站点：（1）持续进行 IPV 培训，（2）进行教育会议和外展访问，以及（3）开发和分发教育材料。有 5 种策略仅存在于早期采用者站点：（4）确定和培养拥护者，（5）改变记录系统以提醒临床医生，（6）通过顾问委员会或工作组创建学习协作，（7）进行审计并提供反馈，并将临床数据传递给提供者，以及（8）获取新资金。
这些策略与解决筛查障碍的文献一致，并有所扩展。有证据表明，在初级保健中有效实施 IPV 筛查需要一整套明确、精心选择的策略。
共同使用的实施策略可以使 IPV 筛查项目在初级保健中得到整合。
