From the Journals

USPSTF advocates screening reproductive age women for intimate partner violence

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Support the recommendations, but don’t stop there

The USPSTF recommendations to screen women of reproductive age for intimate partner violence (IPV) should be supported and implemented, but that should be just a starting point, Karin V. Rhodes, MD, Melissa E. Dichter, PhD, and Kristofer L. Smith, MD, said in an accompanying editorial.

“Given the long-term and wide-ranging harms of abuse, and increased health care utilization and costs of care related to abuse, health systems should begin to expand screening and to test interventions for abuse beyond the recommendations to include older women, men, and elderly and vulnerable populations,” they said, and called on federal, state, and commercial insurance companies to pay for IPV screening for these groups as well as for women of reproductive age.

The recommendations show a notable lack of advancement since those issued in 2013, the editorialists noted. The evidence remains inconclusive to support expanded screening to elders and vulnerable adults. However, evidence-based research is challenging in these groups because randomized, controlled trials involving abuse patients are rare given the ethical considerations of offering care to all abuse victims.

They offered some ideas for improving and expanding screening and enabling evidence-based research, including the use of patient portals and patient-administered screening, as well as making use of the medical home model and coordinating with community-based services.

“It is critical, however, that screening for abuse be conducted with careful attention to confidentiality, safety, and respect for individual self-determination in documentation and follow-up intervention,” the editorialists wrote.

“Such care in screening processes may facilitate disclosure; and, even if patients do not disclose, screening may still have an educational and therapeutic benefit,” they concluded.

Dr. Rhodes and Dr. Smith are affiliated with Hofstra/Northwell, Manhasset, N.Y. Dr. Dichter is affiliated with the University of Pennsylvania, Philadelphia. They had no financial conflicts to disclose. Their editorial accompanying the report by Curry SJ et al. appeared in JAMA 2018 Oct 23/30;320(16):1645-7.


 

FROM JAMA

All women of reproductive age should be screened for intimate partner violence, according to updated recommendations from the U.S. Preventive Services Task Force.

Intimate partner violence (IPV), defined to include sexual violence, physical violence, and stalking, occurs in approximately 36% of women and 33% of men in the United States, the Task Force members said.

An incident of domestic viokence is shown, with a man threatening his partner. Photodisc/Thinkstock

The screening of women of reproductive age is a B recommendation. However, evidence remains insufficient to recommend routine screening for IPV for men, and screening for abuse in elders and vulnerable adult populations received an I statement based on insufficient evidence to assess the balance of risks and benefits, wrote Susan J. Curry, PhD, of the University of Iowa, Iowa City, and her colleagues. Vulnerable adults were defined as those who are not able to protect themselves because of age, disability, or both. The recommendations were published in JAMA.

The Task Force reviewed the available evidence and determined that screening tools can help identify intimate partner violence in women of reproductive age, and that support services can reduce the risk of physical, sexual, and psychological abuse in these women.

In the evidence review accompanying the recommendations, Cynthia Feltner, MD, MPH, of the University of North Carolina, Chapel Hill, and her colleagues analyzed data from 30 studies including 14,959 individuals.

They reviewed studies of IPV for adolescents through women in their 40s and identified several screening tools that accurately detected IPV in adult women within the past year: Humiliation, Afraid, Rape, Kick (HARK); Hurt, Insulted, Threaten, Scream (HITS); Extended–Hurt, Insult, Threaten, Scream (E-HITS); Partner Violence Screen (PVS); and Woman Abuse Screening Tool (WAST). The sensitivity of these tools ranged from 65% to 87%, and specificity ranged from 80% to 95%.

Data from three randomized, controlled trials including 3,759 women found no benefit to screening them for IPV over 3-18 months, but no randomized, controlled trials found any harms associated with screening.

In addition, the data showed no evidence that screening reduced IPV or improved quality of life over a 3-18-month period, the researchers noted.

In addition, the Task Force researchers found no reliable screening tools to identify IPV in men or to identify abuse of elders or vulnerable adults in the absence of recognized signs and symptoms of abuse.

The complete recommendations are available online in JAMA, and on the USPSTF website: http://www.uspreventiveservicestaskforce.org.

The USPSTF is supported by the Agency for Healthcare Research and Quality. The researchers had no financial conflicts to disclose.

SOURCES: Curry SJ et al. JAMA. 2018;320(16):1678-87; Feltner C et al. JAMA. 2018;320(16):1688-701.

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