News Release

UK study shows that a general practice domestic violence training program greatly increases referral of women to domestic violence advocacy organizations (IRIS study)

Peer-Reviewed Publication

The Lancet_DELETED

Domestic violence is a severe breach of human rights with long term health consequences for its victims. General practitioners (GPs) and practice nurses given specialist training to ask their patients about domestic violence and a simple referral pathway to advocacy organisations are 22 times more likely to record referral of women experiencing abuse than GPs and nurses without this specialist training. The findings are reported in an Article published Online First by The Lancet, written by Professor Gene Feder, and colleagues at the University of Bristol and Barts and the London School of Medicine and Dentistry, UK .

Most clinicians have no training about domestic violence, fail to identify patients experiencing abuse, and are uncertain about management after disclosure. This new study included general practices from two heavily populated UK urban areas: Bristol and Hackney (London). The intervention programme included two 2-hour multidisciplinary training sessions, a prompt within the medical record to ask about abuse, and a referral pathway to a named domestic violence advocate, if that was what the woman wanted. Domestic violence advocacy includes provision of legal, housing, financial and safety planning advice, and facilitation of access to community resources, such as refuges or shelters, emergency housing, and psychological support. The collaborating advocacy organisations (Next Link, Bristol and the nia project, Hackney) also delivered the training and further consultancy.

51 (61%) of a total 84 eligible general practices in Hackney and Bristol were randomised in the study. Of these, 24 received a training and support programme, 24 did not receive the programme (control group), and three dropped out before the trial started. 1 year after the second training session, the recorded referral rate in the intervention practices was 22 times higher than in the control group (223 referrals vs 12), although this improvement is from a low baseline. Intervention practices also recorded around 3 times the number of women disclosing domestic violence (641 vs 236). No adverse events were recorded in the study.

The authors say: "The substantial difference in referrals is strong evidence that the intervention improves the response of clinicians to women experiencing domestic violence and enables access to domestic violence advocacy that can reduce re-victimisation and improve quality of life and possibly mental health outcomes. Our findings reduce the uncertainty about the benefit of domestic violence training and support interventions in primary care settings, particularly outside north America, and show that screening is not a necessary condition for benefit."

They conclude: "Worldwide, clinicians within primary care and other health-care settings are not responding adequately to domestic violence. In this study, we show the effectiveness of a brief intervention of training and support with a simple referral pathway to domestic violence advocacy."

Professor Feder adds*: "The IRIS trial shows it is possible to link health services to domestic violence organisations at a time when these organisations, where they exist, are being cut or closed down. They are crucial for supporting women experiencing domestic violence."

In a linked Comment, Dr Kelsey Hegarty, General Practice and Primary Health Care Academic Centre, University of Melbourne, Australia; and Dr Paul Glasziou, Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia, write: "Overall, this is a very well designed and implemented trial of an educational and systems intervention, applicable to the UK setting." They ask "Did the intervention make a difference to the health and wellbeing of abused women? As the authors acknowledge, the main issue is the low rate of referrals and disclosures at baseline…Is this result clinically significant? Is the intervention a good investment of time and resources? The evidence is certainly promising for advocacy, but whether the small increase of women referred for advocacy would translate into better outcomes for women is unknown."

They conclude: "The results here are analogous to a promising phase 2 trial of cancer chemotherapy. Some might wish to fully implement the intervention now. Others would ask for further assessment."

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Professor Gene Feder, University of Bristol, UK. T) +44 (0) 7717224342 E) gene.feder@bristol.ac.uk

Dr Kelsey Hegarty, General Practice and Primary Health Care Academic Centre, University of Melbourne, Australia. T) +61 401488304 E) k.hegarty@unimelb.edu.au

Note to editors: *Quote direct from author and not found in Article


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