Issue 2 / 29 January 2013

AN Australian expert says a US recommendation to screen all women of child-bearing age for intimate partner violence is not expected to influence practice here.

Associate Professor Kelsey Hegarty, head of the University of Melbourne’s Abuse and Violence Research Program, said while the recommendation from the US Preventive Services Task Force raised the profile of this neglected area, it was based on evidence relevant to the US.

Professor Hegarty said the WHO and the Cochrane Collaboration would soon release guidelines on intimate partner violence (IPV) based on global systematic reviews and these would be more relevant to Australian practice.

The US Task Force’s recommendations, published in the Annals of Internal Medicine, said that clinicians should screen women of childbearing age — defined as 14 to 46 years — for IPV, such as domestic violence, overturning the body’s 2004 recommendation that there was insufficient evidence to support screening. (1)

The report said almost 31% of women and 26% of men reported experiencing some form of IPV in their lifetime. “Approximately 25% of women and 14% of men have experienced the most severe types of IPV in their lifetime”, the report said.

Professor Hegarty said the rates of IPV would be much the same in Australia. Initial findings from the Victorian Women’s Evaluation of Abuse and Violence Care (WEAVE) trial, of which Professor Hegarty was lead author, found that about 13% of the 5800 women surveyed through 55 general practitioners had been afraid of their partner or ex-partner in the previous 12 months. (2)

The full results of the WEAVE randomised controlled trial, which evaluates methods of detecting and managing IPV and is the first of its type in general practice, are expected to be published in The Lancet later this year.

Professor Hegarty said a Cochrane Review on screening for IPV in health care settings, which she coauthored, would also provide guidance on this issue when it was published in the first half of this year.

Associate Professor Angela Taft, lead author of the Cochrane Review and acting director of Mother and Child Health Research at La Trobe University, said addressing IPV was a complex intervention.

“Most women don’t mind being asked [about IPV] because they think it’s good for other women”, Professor Taft told MJA InSight. However, she said there was mixed evidence about the willingness of abused women to be screened.

There was also no good evidence comparing the effectiveness of screening for IPV with case finding, and clinicians faced many barriers to screening, Professor Taft said.

“I would suggest that about 10% of doctors and nurses are very comfortable with psychosocial issues, about 40% see it as their duty of care, and the other half aren’t comfortable at all, and all of them need regular training and systems support”, she said.

Guidelines published by the Royal Australian College of General Practitioners — Abuse and violence: working with our patients in general practice — state that there is insufficient evidence for screening for IPV in clinical settings. (3)

Guidelines coauthor Dr Elizabeth Hindmarsh said much groundwork would need to be done before Australia could adopt a broader approach to screening for IPV, as recommended in the US.

“You can’t expect that [level of screening] to happen without a great deal of training for GPs”, Dr Hindmarsh said.

However, she said a 2004 Victorian “burden of disease” study indicated that the US was targeting the age group most at risk of IPV. (4)

“We know that for women between the ages of 15 and 44 … their most likely cause of death would be from intimate partner abuse”, Dr Hindmarsh said.

The US Preventive Services Task Force also evaluated the case for screening elderly or vulnerable adults for abuse or neglect, but found there was insufficient evidence of benefit in screening this group.

– Nicole MacKee

1. Ann Intern Med 2013; Online 22 January
2. Aust J Prim Health 2012; 18: 327-331
3. RACGP 2008; Abuse and violence: working with our patients in general practice
4. VicHealth 2004; The health costs of violence: measuring the burden of disease caused by intimate partner violence

Posted 29 January 2013

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