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
Acknowledgment: The authors thank their collaborators, including Brenda McDowell and Bill Wetzel, for assistance with the planning phase by setting up of clinic for on-site screening and interviews, preparation of the research ethics application, modifications of the computer survey, and pilot testing. They also thank Natasha Driver, Shahjereen Shahidullah, Michelle DeIrish, and Sarah Keenan for their diligent research assistance in the recruitment and coding. Finally, they thank Karin V. Rhodes and colleagues for sharing Promote Health.
Grant Support: The study contributed toward doctoral and fellowship training of Dr. Ahmad, which was funded by the Canadian Institutes of Health Research (grants IGF 63976 and FOW 68219): Institute of Gender & Health, Ontario Women's Health Council, and Strategic Training on Health Care, Place & Technology Program. The authors gratefully acknowledge the support of the Ontario Ministry of Health and Long-Term Care. Support from the Centre for Research on Inner City Health, The Keenan Research Centre, in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, is much appreciated.
Potential Financial Conflicts of Interest: None disclosed.
Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Ahmad (e-mail, firstname.lastname@example.org). Data set: Limited data set available from Dr. Ahmad (e-mail, email@example.com) after written agreement.
Requests for Single Reprints: Farah Ahmad, MBBS, MPH, PhD, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Ahmad: University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada.
Dr. Hogg-Johnson: Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, Ontario M5G 2E9, Canada.
Dr. Stewart: University Health Network, 200 Elizabeth Street, 7EN-229, Toronto, Ontario M5G 2C4, Canada.
Dr. Skinner: York University, Faculty of Health, 403 HNES, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.
Dr. Glazier: Centre for Research on Inner City Health, 70 Richmond, 4th Floor, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
Dr. Levinson: Department of Medicine, University of Toronto, 190 Elizabeth Street, Suite 3-805, Toronto, Ontario M5G 2C4, Canada.
Author Contributions: Conception and design: F. Ahmad, S. Hogg-Johnson, D.E. Stewart, H.A. Skinner, R.H. Glazier, W. Levinson.
Analysis and interpretation of the data: F. Ahmad, S. Hogg-Johnson, D.E. Stewart, W. Levinson.
Drafting of the article: F. Ahmad, H.A. Skinner.
Critical revision of the article for important intellectual content: F. Ahmad, S. Hogg-Johnson, D.E. Stewart, H.A. Skinner, R.H. Glazier, W. Levinson.
Final approval of the article: F. Ahmad, S. Hogg-Johnson, D.E. Stewart, H.A. Skinner, R.H. Glazier, W. Levinson.
Provision of study materials or patients: F. Ahmad.
Statistical expertise: F. Ahmad, S. Hogg-Johnson, H.A. Skinner.
Obtaining of funding: F. Ahmad, W. Levinson.
Administrative, technical, or logistic support: F. Ahmad.
Collection and assembly of data: F. Ahmad.
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 (n = 144). Control participants received standard medical care (n = 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 (n = 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.
Example of a physician report printed by Promote Health.
Coding scheme for the audiotaped physician–patient interactions.
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.
Table 3. IPVC and Other Health Risks: Complete-Case Relative Risk Analyses
Study flow diagram.
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.
Table 1. Patient and Physician Characteristics
Table 2. Prevalence of Self-reported Intimate Partner Violence and Control
Appendix Table. IPVC and Other Health Risks: Intention-to-Treat Analysis With Missing Observations Replaced
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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.
Hospital Medicine, Infectious Disease, Prevention/Screening, Sexually Transmitted Infections, Tobacco, Alcohol, and Other Substance Abuse.
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