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亲密伴侣暴力:初级保健环境中当前筛查实践的分析

Intimate partner violence: analysis of current screening practices in the primary care setting.

作者信息

Perone Hanna R, Dietz Noella A, Belkowitz Julia, Bland Sarah

机构信息

Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami.

North Broward Hospital District d/b/a Broward Health, Fort Lauderdale.

出版信息

Fam Pract. 2022 Jan 19;39(1):6-11. doi: 10.1093/fampra/cmab069.

Abstract

BACKGROUND

Intimate partner violence (IPV) is a largely undetected occurrence in the United States reported by 36-50% of women in their lifetime and associated with extensive physical and psychological implications. Currently, conflicting recommendations exist regarding screening practices with the United States Preventative Services Task Force (USPSTF) and the World Health Organization (WHO) advocating for and against universal screening, respectively. With research suggesting that women are seldom asked about IPV during clinic visits, further information is needed regarding current screening practices.

OBJECTIVES

To identify current IPV screening approaches in the primary care setting and factors that may impact screening completion.

METHODS

We retrospectively examined patients presenting for annual examinations at four university-associated primary care clinics in southeast Florida (n = 400). Patient demographics, screener demographics, screening completion, and screening results were collected from the medical record. Results were compared to depression and anxiety screenings due to comparable prevalence and screening recommendations. Pearson chi square and Fisher exact tests were utilized to compare screening rates by demographic characteristics.

RESULTS

IPV screening occurred at a much lower frequency (8.5%) compared to screenings for anxiety (37.3%) and depression (71.3%). Among documented IPV screenings, 64.7% of encounters resulted in patient refusal to be screened. Screening rates were found to be marginally impacted by patient ethnicity (P = 0.052).

CONCLUSIONS

Findings of both low screening rates and low screening success raise significant concerns for the shortcomings of advocating for universal IPV screening. Therefore, additional studies are necessary to identify covert barriers to screening completion before universal inquiry is advised.

摘要

背景

亲密伴侣暴力(IPV)在美国很大程度上未被察觉,据报道,36%至50%的女性一生中曾遭受过,且会带来广泛的身体和心理影响。目前,美国预防服务工作组(USPSTF)和世界卫生组织(WHO)在筛查做法上存在相互矛盾的建议,前者主张普遍筛查,后者则反对。研究表明,在临床就诊期间,女性很少被问及是否遭受亲密伴侣暴力,因此需要更多关于当前筛查做法的信息。

目的

确定初级保健环境中当前的亲密伴侣暴力筛查方法以及可能影响筛查完成情况的因素。

方法

我们回顾性研究了佛罗里达州东南部四家大学附属初级保健诊所进行年度检查的患者(n = 400)。从病历中收集患者人口统计学信息、筛查人员信息、筛查完成情况和筛查结果。由于患病率和筛查建议具有可比性,将结果与抑郁症和焦虑症筛查进行了比较。采用Pearson卡方检验和Fisher精确检验按人口统计学特征比较筛查率。

结果

与焦虑症筛查(37.3%)和抑郁症筛查(71.3%)相比,亲密伴侣暴力筛查的频率要低得多(8.5%)。在有记录的亲密伴侣暴力筛查中,64.7%的检查导致患者拒绝接受筛查。发现筛查率受患者种族的影响微乎其微(P = 0.052)。

结论

筛查率低和筛查成功率低的结果引发了对普遍倡导亲密伴侣暴力筛查缺点的严重担忧。因此,在建议进行普遍询问之前,有必要进行更多研究以确定影响筛查完成的潜在障碍。

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