Farah Ahmad, MBBS, MPH, PhD; Sheilah Hogg-Johnson, PhD; Donna E. Stewart, MD; Harvey A. Skinner, PhD, CPsych; Richard H. Glazier, MD, MPH; Wendy Levinson, MD
Ahmad F, Hogg-Johnson S, Stewart DE, Skinner HA, Glazier RH, Levinson W. Computer-Assisted Screening for Intimate Partner Violence and Control: A Randomized Trial. Ann Intern Med. 2009;151:93-102. doi: 10.7326/0003-4819-151-2-200907210-00124
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Published: Ann Intern Med. 2009;151(2):93-102.
Intimate partner violence and control (IPVC) is prevalent and can be a serious health risk to women.
To assess whether computer-assisted screening can improve detection of women at risk for IPVC in a family practice setting.
Randomized trial. Randomization was computer-generated. Allocation was concealed by using opaque envelopes that recruiters opened after patient consent. Patients and providers, but not outcome assessors, were blinded to the study intervention.
An urban, academic, hospital-affiliated family practice clinic in Toronto, Ontario, Canada.
Adult women in a current or recent relationship.
Computer-based multirisk assessment report attached to the medical chart. The report was generated from information provided by participants before the physician visit (nÂ = 144). Control participants received standard medical care (nÂ = 149).
Initiation of discussion about risk for IPVC (discussion opportunity) and detection of women at risk based on review of audiotaped medical visits.
The overall prevalence of any type of violence or control was 22% (95% CI, 17% to 27%). In adjusted analyses based on complete cases (nÂ = 282), the intervention increased opportunities to discuss IPVC (adjusted relative risk, 1.4 [CI, 1.1 to 1.9]) and increased detection of IPVC (adjusted relative risk, 2.0 [CI, 0.9 to 4.1]). Participants recognized the benefits of computer screening but had some concerns about privacy and interference with physician interactions.
The study was done at 1 clinic, and no measures of women's use of services or health outcomes were used.
Computer screening effectively detected IPVC in a busy family medicine practice, and it was acceptable to patients.
Canadian Institutes of Health Research and Ontario Women's Health Council.
Domestic violence is difficult to recognize, and screening is often difficult to implement.
This randomized trial found that when a computer-generated report detailing patients' responses to questions about intimate partner violence and control was attached to medical charts, family practitioners asked about it and detected it more often.
The trial was conducted at a single family practice clinic in Canada.
Computer-assisted screening for intimate partner violence and control led to improved detection in a busy ambulatory care setting.
Shaded areas represent measured primary outcomes; after training, intercoder reliability was good for all measures (κ = 0.82 to 1.0).
* “Discussion opportunity” refers to whether the patient or physician raised the possibility of the patient being at risk for intimate partner violence or control.
IQR = interquartile range.
* Informed consent could not be completed because patients were called into visit (n = 40) or the research room was busy (n = 29).
† 1 patient left before the visit because the physician was behind schedule; 2 physicians canceled the visits because of personal emergency; and 1 physician assigned the visit to a resident.
‡ The physician withdrew because the participant had mental health issues.
§ The physician and patient conversed in a language not understood by the coders.
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