Study finds - and plugs - medical gap in domestic-abuse prevention

Given the right training, doctors at fracture clinics can do more than treat broken bones in suspected domestic abuse cases but aren’t always confident how to handle the job, an abuse-prevention study finds.

With as many as one in six women patients at fracture clinics experiencing some form of intimate partner abuse within the previous year, researchers educated orthopedic surgeons and hospital clinic staff – including 10 at the London Health Sciences Centre (LHSC) – about the right questions to ask, and what to do, when a patient is abused at home.

While it may seem like asking such patients about abuse is an obvious response in front-line health care, the reality can be much more difficult.

“I think all wanted to say something, but they didn’t really know what to say or how to handle it,” said Dr. Sheila Sprague, associate director at the Centre for Evidence-Based Orthopedics at Hamilton’s McMaster University and lead study author.

“We thought this might be a gap in care that we could work to address,” she said.

Researchers recruited 140 participants from seven fracture clinics in Canada and the U.S. to complete the two-hour education program. Those who took part included orthopedic surgeons, other health care workers who aren’t doctors and administrators.

The study authors surveyed the participants’ attitudes, knowledge and self-reported behaviour before, immediately after and three months after they completed the so-called EDUCATE training on addressing domestic violence.

After the program, they reported feeling more knowledgeable about intimate partner violence, more confident about raising the subject with patients and more ready to handle a patient who admits they’re dealing with it.

The study was published in the Canadian Medical Association Journal.

“We worked with each of the fracture clinics to come up with a plan – to have a number of resources that women could be provided with, to know who to call within the hospital setting, like the social works department,” Sprague said.

Asking a patient if they’re being abused can feel awkward or inappropriate for a doctor treating a fracture,  Dr. Emil Schemitsch, LHSC’s chief of surgery and a study collaborator, said.

Knowing what to say and do, or where to refer a patient who admits they’re being abused, can be a bit daunting for busy clinicians, as well.

The role of orthopedic clinicians in domestic violence-detection wasn’t always well understood before the  program, Schemitsch said. Some doctors knew how to bring it up with patients, some knew where they could refer people, but many didn’t know their role, he added.

“People don’t know, first of all, what kind of questions to ask to get the conversation going,” he said. “It is not necessarily information the average trainee has readily at hand. This program educates people and gives them both information and an approach about how to interact with patients.”

Previous research has found that one in 50 women visiting a fracture clinic with a broken bone received it from a domestic violence incident, Schemitsch said.

Fracture clinic doctors are well-suited to screen for domestic abuse since broken bones require follow-up appointments, Schemitsch said.

“It’s an opportunity to establish a relationship with a patient and then eventually get them to understand that they’re more than just a fracture, they’re a person,” he said.

The program to education health care workers on intimate partner violence, and the positive outcomes of the study, were applauded by Megan Walker, executive director of the London Abused Women’s Centre.  In the past, she said, there’ve been similar pushed on other medical settings to routinely screen for domestic abuse.

“I think it’s absolutely fantastic,” she said. “If women are asked, they’re likely to disclose but they are not likely to voluntarily disclose. It has a definite positive impact on women when we just simply ask the question.”

Walker said taking the chance to intervene and guide domestic violence victims to resources can make a big difference.

“I always say every woman that’s referred to a counselling agency for intimate partner abuse, you are potentially saving that woman’s life,” she said.

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domestic-abuse prevention plugs - medical gap
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