This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (144)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Primary Care/ Family Medicine  • Violence and Human Rights, Other  • Alert me on articles by topic

Practices and Attitudes of Primary Care Physicians

Michael A. Rodriguez, MD, MPH; Heidi M. Bauer, MD, MPH; Elizabeth McLoughlin, ScD; Kevin Grumbach, MD

JAMA. 1999;282:468-474.

Context  Although practice guidelines encouraging the screening of patients for intimate partner abuse have been available for several years, it is unclear how well and in which circumstances physicians adhere to them.

Objective  To describe the practices and perceptions of primary care physicians regarding intimate partner abuse screening and interventions.

Design, Setting, and Participants  Cross-sectional survey of a stratified probability sample of 900 physicians practicing family medicine, general internal medicine, and obstetrics/gynecology in California. After meeting exclusion criteria, 582 were eligible for participation in the study.

Main Outcome Measure  Reported abuse screening practices in a variety of clinic settings, based on a 24-item questionnaire, with responses compared by physician sex, practice setting, and intimate partner abuse training.

Results  Surveys were completed by 400 (69%) of the 582 eligible physicians, including 149 family physicians, 115 internists, and 136 obstetrician/gynecologists. Data were weighted to estimate the practices of primary care physicians in California. An estimated majority (79%; 95% confidence interval [CI], 75%-83%) of these primary care physicians routinely screen injured patients for intimate partner abuse. However, estimated routine screening was less common for new patient visits (10%; 95% CI, 7%-13%), periodic checkups (9%; 95% CI, 6%-12%), and prenatal care (11%; 95% CI, 7%-15%). Neither physician sex nor recent intimate partner abuse training had significant effects on reported new patient screening practices. Obstetrician/gynecologists (17%) and physicians practicing in public clinic settings (37%) were more likely to screen new patients. Internists (6%) and physicians practicing in health maintenance organizations (1%) were least likely to screen new patients. Commonly reported routine interventions included relaying concern for safety (91%), referral to shelters (79%) and counseling (88%), and documentation in the medical chart (89%). Commonly cited barriers to identification and referral included the patients' fear of retaliation (82%) and police involvement (55%), lack of patient disclosure (78%) and follow-up (52%), and cultural differences (56%).

Conclusions  These findings suggest that primary care physicians are missing opportunities to screen patients for intimate partner abuse in a variety of clinical situations. Further studies are needed to identify effective intervention strategies and improve adherence to intimate partner abuse practice guidelines.

Author Affiliations: The Pacific Center for Violence Prevention (Drs Rodriguez and McLoughlin), the Department of Family and Community Medicine (Drs Rodriguez, Bauer, and Grumbach), the Primary Care Research Center (Dr Grumbach), the Center for Aging in Diverse Communities and Medical Effectiveness Research Center (Drs Rodriguez and Grumbach), University of California, San Francisco.

RELATED ARTICLE

August 4, 1999
JAMA. 1999;282(5):497-498.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

(Mis)Perceptions About Intimate Partner Violence in Women Presenting for Orthopaedic Care: A Survey of Canadian Orthopaedic Surgeons
Bhandari et al.
JBJS 2008;90:1590-1597.
ABSTRACT | FULL TEXT  

Interactions Between Victims of Intimate Partner Violence Against Women and the Health Care System: Policy and Practice Implications
Plichta
Trauma Violence Abuse 2007;8:226-239.
ABSTRACT  

Violence involving intimate partners: Prevalence in Canadian family practice
Ahmad et al.
cfp 2007;53:460-468.
ABSTRACT | FULL TEXT  

Using Indirect Questions to Detect Intimate Partner Violence: The SAFE-T Questionnaire
Fulfer et al.
J Interpers Violence 2007;22:238-249.
ABSTRACT  

Discussing partner abuse: does doctor's gender really matter?
Wong et al.
Fam Pract 2006;23:578-586.
ABSTRACT | FULL TEXT  

Intimate Partner Violence Resource Materials: Assessment of Information Distribution.
Edwardsen and Morse
J Interpers Violence 2006;21:971-981.
ABSTRACT  

Physical and Sexual Violence During Pregnancy and After Delivery: A Prospective Multistate Study of Women With or at Risk for HIV Infection
Koenig et al.
Am. J. Public Health 2006;96:1052-1059.
ABSTRACT | FULL TEXT  

Successful integration and maintenance of screening for domestic violence in the health sector: moving beyond individual responsibility.
Thurston and Eisener
Trauma Violence Abuse 2006;7:83-92.
ABSTRACT  

Enhancing Participant Recruitment in Studies of Sensitive Topics
Records and Rice
J Am Psychiatr Nurses Assoc 2006;12:28-36.
ABSTRACT  

Women's Views of Prenatal Violence Screening: Acceptability and Confidentiality Issues
Renker and Tonkin
Obstet Gynecol 2006;107:348-354.
ABSTRACT | FULL TEXT  

Screening for domestic violence in a predominantly Hispanic clinical setting
Chen et al.
Fam Pract 2005;22:617-623.
ABSTRACT | FULL TEXT  

Mutable Influences on Intimate Partner Abuse Screening in Health Care Settings: A Synthesis of the Literature
Stayton and Duncan
Trauma Violence Abuse 2005;6:271-285.
ABSTRACT  

Survivor Preferences for Response to IPV Disclosure
Dienemann et al.
Clin Nurs Res 2005;14:215-233.
ABSTRACT  

Health Care Workers' Expectations and Empathy toward Patients in Abusive Relationships
Nicolaidis et al.
J Am Board Fam Med 2005;18:159-165.
ABSTRACT | FULL TEXT  

Patients' Advice to Physicians About Intervening in Family Conflict
Burge et al.
Ann Fam Med 2005;3:248-254.
ABSTRACT | FULL TEXT  

Homicide: A Leading Cause of Injury Deaths Among Pregnant and Postpartum Women in the United States, 1991-1999
Chang et al.
Am. J. Public Health 2005;95:471-477.
ABSTRACT | FULL TEXT  

Intimate Partner Violence and Physical Health Consequences: Policy and Practice Implications
Plichta
J Interpers Violence 2004;19:1296-1323.
ABSTRACT  

Intimate Partner Violence: What Are Physicians' Perceptions?
Zink et al.
J Am Board Fam Med 2004;17:332-340.
ABSTRACT | FULL TEXT  

Domestic Violence: Prevalence and Detection in a Family Medicine Residency Clinic
Wenzel et al.
JAOA: Journal of the American Osteopathic Association 2004;104:233-239.
ABSTRACT | FULL TEXT  

Medical Management of Intimate Partner Violence Considering the Stages of Change: Precontemplation and Contemplation
Zink et al.
Ann Fam Med 2004;2:231-239.
ABSTRACT | FULL TEXT  

Incomplete and biased perpetrator coding among hospitalized assaults for women in the United States
Weiss et al.
Inj. Prev. 2004;10:119-121.
ABSTRACT | FULL TEXT  

Screening for Partner Violence: Direct Questioning or Self-Report?
Webster and Holt
Obstet Gynecol 2004;103:299-303.
ABSTRACT | FULL TEXT  

Are Reproductive Health Services a Good Place to Screen for Intimate Partner Violence?: Evidence from Bolivia
McCarraher et al.
Violence Against Women 2003;9:989-1002.
ABSTRACT  

Screening for Intimate Partner Violence when Children are Present: The Victim's Perspective
Zink and Jacobson
J Interpers Violence 2003;18:872-890.
ABSTRACT  

Interventions for Violence Against Women: Scientific Review
Wathen and MacMillan
JAMA 2003;289:589-600.
ABSTRACT | FULL TEXT  

Prevalence of Sexual Abuse Among Women Seeking Gynecologic Care in Germany
Peschers et al.
Obstet Gynecol 2003;101:103-108.
ABSTRACT | FULL TEXT  

Screening for domestic violence
Nurse et al.
BMJ 2002;325:1417-1417.
FULL TEXT  

Parental Screening for Intimate Partner Violence by Pediatricians and Family Physicians
Borowsky and Ireland
Pediatrics 2002;110:509-516.
ABSTRACT | FULL TEXT  

Examining Homicide's Contribution to Pregnancy-Associated Deaths
Frye
JAMA 2001;285:1510-1511.
FULL TEXT  

Perceptions of Health Status and the Relationship With Abuse History and Mental Health in Low-Income Single Mothers
Lutenbacher
Journal of Family Nursing 2000;6:320-340.
ABSTRACT  

Who Gets Screened During Pregnancy for Partner Violence?
Clark et al.
Arch Fam Med 2000;9:1093-1099.
ABSTRACT | FULL TEXT  

Primary Care Physicians Miss Chances to Screen for Partner Abuse
JWatch Psychiatry 1999;1999:18-18.
FULL TEXT  

Partner Abuse Still a Problem
JWatch Women's Health 1999;1999:19-19.
FULL TEXT  

Primary Care Physicians Miss Chances to Screen for Partner Abuse
JWatch General 1999;1999:6-6.
FULL TEXT  

What Can We Do About Violence?
Cole and Flanagin
JAMA 1999;282:481-483.
FULL TEXT