在基层医疗机构持续开展为期 12 个月的 IPV 筛查和响应计划：影响实施成功的环境因素。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues Pub Date : 2024-11-01 DOI:10.1016/j.whi.2024.07.001

Katherine M. Iverson PhD , Julianne E. Brady MA , Omonyêlé L. Adjognon ScM , Kelly Stolzmann MS , Melissa E. Dichter PhD, MSW , LeAnn E. Bruce PhD, LCSW , Galina A. Portnoy PhD , Samina Iqbal MD , Megan R. Gerber MD, MPH , Sally G. Haskell MD , Christopher J. Miller PhD

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引用次数: 0

摘要

目的：退伍军人健康管理局（VHA）采用了实施促进（IF）策略，以提高初级保健中亲密伴侣暴力（IPV）筛查项目的接受率。本研究考察了 IF 实施 1 年后筛查吸收率的持续情况，并确定了影响持续成功的因素：方法：采用定量和定性数据进行了混合方法评估。从综合框架期结束（即初始采用）到 1 年持续期的 IPV 筛查率是主要结果。我们将筛查采用率和持续成功率的地点分为四组（高采用率和高持续成功率、中等采用率和中等持续成功率、低采用率和低持续成功率、未采用率和/或未持续成功率）。通过对关键信息提供者访谈的定性分析，确定了影响筛查 12 个月后的背景因素。混合持续性分析矩阵综合了定量和定性分析结果，并确定了跨站点模式：九个地点中有七个在最基本的水平上维持了 IPV 筛查（筛查率保持不变或有所提高）。采用率高和持续率高的医疗点（n = 3）具有以下特点：医疗中心领导始终如一的支持、对临床医生的持续培训、明确的阳性筛查应对方案，以及为遭受 IPV 的妇女提供健全的转诊选择。非持续性医疗点（n = 2）则存在一系列障碍，包括人员短缺、优先事项相互竞争、领导层对 IPV 筛查重要性的宣传不一致等：结论：了解成功维持 IPV 筛查的障碍和促进因素可为医疗保健系统提供信息，以调整综合框架和其他实施策略，从而维持初级医疗保健中的 IPV 筛查。维持 IPV 筛查需要关注促进因素（如领导层的一贯支持和强大的转诊选择）以及解决关键障碍（如人员流动和相互竞争的优先事项）的组合。

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Twelve-Month Sustainment of IPV Screening and Response Programs in Primary Care: Contextual Factors Impacting Implementation Success

Purpose

The Veterans Health Administration (VHA) employed implementation facilitation (IF) as a strategy to boost uptake of intimate partner violence (IPV) screening programs in primary care. This study examined the sustainment of screening uptake 1 year after IF and identified factors impacting sustainment success.

Methods

A mixed-methods evaluation using quantitative and qualitative data was conducted. IPV screening rates from the conclusion of the IF period (i.e., initial adoption) through the 1-year sustainment period served as the primary outcome. We categorized sites into four groups of screening adoption and sustainment success (high adoption and high sustainment, moderate adoption and moderate sustainment, low adoption and low sustainment, and no adoption and/or no sustainment). Qualitative analysis of key informant interviews was used to identify contextual factors affecting screening 12 months post-IF. A mixed sustainment analysis matrix integrated quantitative and qualitative findings and enabled the identification of cross-site patterns.

Main Findings

Seven of the nine sites sustained IPV screening at the most basic level (saw static or increased screening rates). High adopting and high sustaining sites (n = 3) were marked by consistently supportive medical center leadership, ongoing training for clinicians, clear protocols for responding to positive screens, and robust referral options for women experiencing IPV. Nonsustaining sites (n = 2) were marked by a host of barriers including staffing shortages, competing priorities, and inconsistent messaging from leadership regarding the importance of IPV screening.

Conclusions

Knowing barriers and facilitators to successful IPV screening sustainment can inform health care systems to tailor IF and other implementation strategies to sustain IPV screening in primary care. Sustainment of IPV screening requires attention to a combination of facilitators (e.g., consistent leadership support and robust referral options) as well as addressing key barriers (e.g., staff turnover and competing priorities).

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来源期刊

Womens Health Issues Multiple-

CiteScore

4.50

自引率

6.20%

发文量

审稿时长

32 days

期刊介绍： Women"s Health Issues (WHI) is a peer-reviewed, bimonthly, multidisciplinary journal that publishes research and review manuscripts related to women"s health care and policy. As the official journal of the Jacobs Institute of Women"s Health, it is dedicated to improving the health and health care of all women throughout the lifespan and in diverse communities. The journal seeks to inform health services researchers, health care and public health professionals, social scientists, policymakers, and others concerned with women"s health.