Knowledge and practices of regional and rural general practitioners in the identification and management of intimate partner and family violence: a mixed methods study in Western Australia.

IF 2 Q2 MEDICINE, GENERAL & INTERNAL
Caroline Crossley, Heath Greville, Daniel Pelkowitz, Amanda Gee, Lindi Pelkowitz, Sandra C Thompson
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引用次数: 0

Abstract

Background: General Practitioners (GPs) are well placed to identify and assist patients experiencing intimate partner violence (IPV) and family violence (FV). However, patients experiencing IPV/FV can be under-detected or inadequately assisted when GPs do not have the necessary confidence, knowledge, attitudes or skills for this. Given the high rates of IPV/FV in the Australian regional setting where this study was conducted, this investigation explored the confidence, knowledge, attitudes and practices of local GPs in identifying and managing patients who are experiencing IPV/FV.

Methods: This mixed methods study utilised a survey tool adapted from a review of existing instruments. The adapted tool included questions on provider confidence, knowledge, attitudes and practices for quantitative analysis, as well as open-response questions that were analysed thematically. All GPs (n = 58) working within the area at the time of the study were invited to participate via emails and written letters distributed through practices and at pre-existing meetings, with 25 completing the survey (43% response rate).

Results: Participants lacked knowledge around GP-facilitated disclosure of abuse, many believing the patient to be the main reason for non-disclosure. Half or fewer respondents indicated confidence in creating safety plans with patients, in making appropriate referrals and in identifying IPV/FV by history, signs and symptoms. There were mostly favourable attitudes towards asking about and assisting with IPV/FV, although only one quarter of respondents believed that individuals experiencing IPV/FV can make appropriate choices about how to handle their situation. In terms of practice, only one third agreed that they could match interventions to patient readiness to change. Other key concerns included difficulties in accessing timely support, with improved coordination of local services and systematic changes in the GP environment being the most common recommendations made by respondents.

Conclusions: This study demonstrated that the responding GPs in a regional area with high rates of IPV/FV have generally favourable attitudes towards identifying and assisting with IPV/FV but lack knowledge and confidence in the practical elements of enquiry. Surprisingly for a regional area, there was poor understanding of local support provision. The findings have the potential to meaningfully inform regional and rural primary care experiences, including desired educational opportunities and enhancing the relationship between health professionals and relevant community organisations. The results support the need for upstream changes in the general practice environment to improve the ability of regional and rural GPs to build relationships with patients over time and enhance overall health outcomes for those affected by abuse.

区域和农村全科医生在识别和管理亲密伴侣和家庭暴力方面的知识和实践:西澳大利亚州的混合方法研究。
背景:全科医生(gp)在识别和帮助遭受亲密伴侣暴力(IPV)和家庭暴力(FV)的患者方面处于有利地位。然而,当全科医生没有必要的信心、知识、态度或技能时,经历IPV/FV的患者可能会被发现不足或得不到充分的帮助。鉴于本研究开展的澳大利亚地区IPV/FV的高发率,本调查探讨了当地全科医生在识别和管理IPV/FV患者方面的信心、知识、态度和做法。方法:这项混合方法研究利用了一种调查工具,该工具改编自对现有工具的回顾。调整后的工具包括关于定量分析的提供者信心、知识、态度和做法的问题,以及按主题分析的开放式回答问题。在研究期间,所有在该地区工作的全科医生(n = 58)都被邀请通过电子邮件和书面信件通过实践和预先会议分发参与,其中25人完成了调查(43%的回复率)。结果:参与者对gp促进的虐待披露缺乏了解,许多人认为患者是不披露的主要原因。一半或更少的应答者表示对与患者一起制定安全计划、作出适当转诊以及根据病史、体征和症状确定IPV/FV有信心。虽然只有四分之一的受访者认为,经历过IPV/FV的个人可以对如何处理他们的情况做出适当的选择,但大多数受访者对询问和协助IPV/FV持赞成态度。在实践方面,只有三分之一的人同意他们可以将干预措施与患者改变的意愿相匹配。其他主要问题包括难以获得及时支助,答复者提出的最常见建议是改进地方服务的协调和系统地改变全科医生的环境。结论:本研究表明,在IPV/FV发生率高的地区,应答的全科医生对识别和协助IPV/FV普遍持积极态度,但对查询的实际要素缺乏知识和信心。令人惊讶的是,作为一个地区,人们对当地的支持措施了解甚少。研究结果有可能为地区和农村初级保健经验提供有意义的信息,包括期望的教育机会和加强卫生专业人员与相关社区组织之间的关系。研究结果表明,需要对全科医疗环境进行上游改革,以提高地区和农村全科医生与患者建立长期关系的能力,并改善受虐待者的整体健康状况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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