Center for General Practice, Aalborg University, Aalborg Ø, Denmark.
Lægefællesskabet Grenå, Aarhus University, Denmark.
Scand J Prim Health Care. 2023 Mar;41(1):81-90. doi: 10.1080/02813432.2023.2178851. Epub 2023 Feb 22.
Maltreated children have many long-term consequences throughout their lives, but often maltreated children are not recognised in time by professionals. General practice could be central to the early recognition of child maltreatment due to the long-term relationship with families.
How do general practitioners (GPs) and practice nurses (PNs) deal with suspected maltreatment in children below 18 years of age, and which factors influence them to report cases to social authorities.
A mixed methods study set in general practice in Denmark.
We combined data from a nationwide questionnaire with observations from five clinics and 20 interviews with GPs and PNs. We explored our data using the concept of uncertainty as a driver that shapes action and decision-making in general practice.
Most GPs (94%) said they would discuss cases of suspected child maltreatment with social services, but in many cases they would prefer to discuss their suspicions with a colleague first (83%) - most likely where there are no clear-cut signs. The qualitative data added nuance to these findings by highlighting the difficulty of communicating across sectors, the importance of maintaining a connection with the child's family, and practicing watchful waiting.
General practice has an opportunity to act early in cases of suspected child maltreatment if uncertainty is accepted as a critical part of the process of reaching a diagnosis. Communication across sectors is key, as is support for GPs with suspicions and for families in need of help.Key pointsGPs are often thought to underreport child maltreatment but despite low levels of reporting, this does not mean they ignore it.Building on the connection with the family, making follow appointments, and discussing suspicions with colleagues are typical of how GPs manage suspicions of child abuse.Accepting uncertainty as a condition of raising the alarm could help GPs to act quickly to support children at risk of abuse.
受虐待的儿童在其一生中会遭受许多长期后果，但由于与家庭的长期关系，由于受虐待的儿童往往不能及时被专业人员发现。全科医生对于儿童虐待的早期识别至关重要。
全科医生（GP）和执业护士（PN）如何处理 18 岁以下儿童疑似受虐待的情况，以及哪些因素影响他们向社会当局报告病例。
丹麦普通实践中的混合方法研究。
我们将全国范围的问卷调查数据与来自五家诊所的观察结果以及对 20 名 GP 和 PN 的访谈相结合。我们使用不确定性作为驱动因素的概念来探索我们的数据，该概念影响着普通实践中的行动和决策。
大多数 GP（94%）表示他们会与社会服务部门讨论疑似儿童虐待的案件，但在许多情况下，他们更愿意首先与同事讨论他们的怀疑（83%） - 最有可能的情况是没有明确的迹象。定性数据通过突出沟通跨部门的困难、保持与儿童家庭联系的重要性以及进行观察性等待的重要性，为这些发现增添了细微差别。
如果将不确定性视为诊断过程的关键部分，那么普通实践就有机会在疑似儿童虐待的情况下尽早采取行动。跨部门的沟通是关键，对有怀疑的 GP 以及需要帮助的家庭的支持也是如此。
普遍认为全科医生报告儿童虐待的情况较少，但尽管报告水平较低，但这并不意味着他们忽视了这种情况。在与家庭的联系基础上，进行随访预约，并与同事讨论怀疑，这是 GP 管理虐待儿童怀疑的典型做法。将不确定性视为发出警报的条件，可以帮助 GP 迅速采取行动，支持处于虐待风险中的儿童。
