Irina V. Haller, PhD, MS¹, Barbara A. Elliott, PhD², and Jennifer M. Peterson, MSW¹. (1) Division of Education & Research, St. Mary's/Duluth Clinic Health System , 5AV2ME, 400 East 3rd Street, Duluth, MN 55805, 218-786-8185, ihaller@smdc.org, (2) School of Medicine, University of Minnesota, Duluth, 10 University Drive, Duluth, MN 55812

This research evaluated domestic violence (DV) knowledge and self-reported practices of health care providers in a multi-clinic/multi-specialty health system in the upper Midwest. This study was a needs-assessment for provider education and system-wide initiatives to improve screening and management of patients affected by DV. METHODS: The study utilized survey methodology in a cohort of physicians, nurse practitioners (NP) and physician assistants (PA) with direct adult patient contact. Routine (always or often) screening and intervention for DV, major barriers to screening, knowledge of DV resources, and attitudes were analyzed using stepwise logistic regressions, adjusted for gender. Evaluated factors included self-reported training for DV, provider level (physician or NP/PA), practice location (urban or rural), primary or specialty care, and prior experience identifying victims of DV. RESULTS: 227/334 (68%) of eligible providers responded to the survey: 78% of respondents were physicians, 70% practiced in urban settings (population >20,000), 46% were primary care (PC), 30% were female, 84% indicated that they identified victims of abuse in their practice (PC providers were more likely to identify victims, OR:4.8 95%CI:1.9-13.8), and 26% reported having DV CME training within 3 years prior to the survey. Only 13% reported screening routinely for DV during a new patient visit; those who practiced in urban setting were more likely to screen (OR:7.1, 1.9-45.9). One in five (20%) providers reported screening routinely for DV during periodic exams; urban and PC providers were more likely to do so (OR:2.9, 1.1-8.5 and 4.6, 1.7-13.4, respectively). Most providers reported routine screening of patients with injury (71%) or suspicious behavior (81%). The major barriers to screening were patient-related: fearing retaliation (77%), accompanied by partner (61%), not raising the issue (61%), and not following up on referrals (53%). In addition, urban providers were more likely to report patients' cultural norms as a barrier (OR:3.5, 1.7-7.7). PC providers were less likely to report patients being offended as a barrier to asking about DV (OR:0.5, 0.3-0.9). Urban providers were less likely to report having sufficient information about local DV resources (OR:0.3, 0.1-0.5) or personal contacts with local advocates (OR:0.2, 0.1-0.4). No differences in provider attitudes dependent on practice setting were detected. CONCLUSIONS: These results identify potential areas for provider education. The urban/rural and primary/specialty care differences in screening patterns and barriers could reflect differences in relationship between providers and patients in these settings. Education is especially needed in connecting urban providers to local DV resources.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• List provider identified barriers to screening for domestic violence;
• Identify clinical settings in which providers are more likely to screen patients for domestic violence;
• Name specific areas that should be addressed in provider education about screening and management of patients affected by violence.

Keywords: Domestic Violence, Education

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.