Screening for Intimate Partner Violence in Health Care Settings A Randomized Trial
Screening for Intimate Partner Violence in Health Care Settings A Randomized Trial
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DOI：
10.1001/jama.2009.1089
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发表时间：
2009-08-05
影响因子：
120.7
通讯作者：
McNutt, Louise-Anne
中科院分区：
文献类型：
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作者：
MacMillan, Harriet L.;Wathen, C. Nadine;McNutt, Louise-Anne
背景无论是亲密伴侣暴力（IPV）筛查减少暴力或改善妇女的健康结果是unknowed. ObjectiveTo确定IPV筛查的有效性和积极结果的临床医生的沟通，设计，设置，和参与者随机对照试验进行了11个急诊科，12个家庭的做法，和3个产科/妇科诊所在安大略，加拿大，在2005年7月至2006年12月期间就诊的6743名年龄在18至64岁之间的讲英语的女性患者中，可以单独就诊，并且身体状况良好，可以参加。如果一名妇女的检查结果呈阳性，则在保健访问之前将这一信息告知其临床医生。后续讨论和/或转诊由主治临床医生决定。非筛查组（n=3472）在访视后自行完成WAST和其他测量。主要结果测量披露过去一年IPV的妇女在基线和每6个月直到18个月接受关于IPV再暴露和生活质量的访谈（主要结果），以及几个健康结果和筛查的潜在危害。结果参与者失访率高：43%（148/347）的筛查女性和41%（148/360）的未筛查女性。在18个月时（n=411），观察到的IPV复发率在筛查与未筛查妇女中分别为46%和53%（模型比值比，0.82; 95%置信区间，0.32-2.12）。筛查组与未筛查组相比，生活质量评分改善约0.2-SD（18个月时模型评分差异为3.74; 95%置信区间为0.47-7.00）。当使用多重插补来解释样本损失时，组间差异减少，生活质量差异不再显著。筛选妇女报告没有伤害screening.Conclusions虽然样本磨损敦促谨慎的解释，这项试验的结果没有提供足够的证据来支持IPV筛选在医疗机构。在确定IPV后对妇女的服务进行评价仍然是一个优先事项。clinicaltrials.gov 2009;302（5）：493-501 www.jama.com
Context Whether intimate partner violence (IPV) screening reduces violence or improves health outcomes for women is unknown.Objective To determine the effectiveness of IPV screening and communication of positive results to clinicians.Design, Setting, and Participants Randomized controlled trial conducted in 11 emergency departments, 12 family practices, and 3 obstetrics/gynecology clinics in Ontario, Canada, among 6743 English-speaking female patients aged 18 to 64 years who presented between July 2005 and December 2006, could be seen individually, and were well enough to participate.Intervention Women in the screened group (n=3271) self-completed the Woman Abuse Screening Tool (WAST); if a woman screened positive, this information was given to her clinician before the health care visit. Subsequent discussions and/or referrals were at the discretion of the treating clinician. The nonscreened group (n=3472) self-completed the WAST and other measures after their visit.Main Outcome Measures Women disclosing past-year IPV were interviewed at baseline and every 6 months until 18 months regarding IPV reexposure and quality of life (primary outcomes), as well as several health outcomes and potential harms of screening.Results Participant loss to follow-up was high: 43% (148/347) of screened women and 41% (148/360) of nonscreened women. At 18 months (n=411), observed recurrence of IPV among screened vs nonscreened women was 46% vs 53% (modeled odds ratio, 0.82; 95% confidence interval, 0.32-2.12). Screened vs nonscreened women exhibited about a 0.2-SD greater improvement in quality-of-life scores ( modeled score difference at 18 months, 3.74; 95% confidence interval, 0.47-7.00). When multiple imputation was used to account for sample loss, differences between groups were reduced and quality-of-life differences were no longer significant. Screened women reported no harms of screening.Conclusions Although sample attrition urges cautious interpretation, the results of this trial do not provide sufficient evidence to support IPV screening in health care settings. Evaluation of services for women after identification of IPV remains a priority.Trial Registration clinicaltrials.gov Identifier: NCT00182468 JAMA. 2009;302(5):493-501 www.jama.com