Similar yet unique: the victim's journey after acute sexual assault and the importance of continuity of care.

OBJECTIVE: To examen the short-term and long-term responses of sexual assault victims who attended a sexual assault centre. METHODS: Semi-structured interviews were held with twelve victims of sexual assault who received help from a sexual assault centre. Analyses were done in Atlas.ti. via a process of open, axial and selective coding. RESULTS: Shortly after assault, the victims' response was to strike a balance between denial and acknowledgement that the violence was real and not their fault. In the ling term most victims experienced a dynamic recovery process with fluctuating responses. Their social support network played a crucial role in reaching out for professional care. CONCLUSION: Shortly after assault sexual violence victims need the violence to be acknowledged by skilful, empathic care providers. In the long term, victims experience vitims experience a dynamic recovery process with fluctuating responses in which continuity of care is of the utmost importance.

Challenges in interprofessional collaboration: experiences of care providers and policymakers in a newly set-up Dutch assault centre.

BACKGROUND: Sexual and family violence are problems that affect many women and men, and the negative health consequences of violence are numerous. As adequate acute interprofessional care can prevent negative health consequences and improve forensic medical examination, a Centre for Sexual and Family Violence was set up. AIM: We aimed to improve our understanding of the challenges in interprofessional collaboration in a newly set-up centre for sexual and family violence. METHODS: We conducted a qualitative study with semi-structured interviews about the experiences with interprofessional collaboration of 16 stakeholders involved in the Centre for Sexual and Family Violence Nijmegen. Participants were selected by purposive sampling. RESULTS: Participants found that the interprofessional collaboration had improved communication and competences. However, there were challenges too. Firstly, the interprofessional collaboration had brought parties closer together, but the collaboration also forced professionals to strongly define their boundaries. Mutual trust and understanding needed to be built up. Secondly, a balance had to be struck between pursuing the shared vision - which was to improve quality of care for victims - and giving space to organizations' and professionals' own interest. Thirdly, care for victims of sexual and family violence could be demanding on healthcare providers in an emotional sense, which might jeopardize professional's initial motivation for joining the Centre for Sexual and Family Violence Nijmegen. CONCLUSION: The interprofessional collaboration in an assault centre improves quality of care for victims, but there are also challenges. The tasks of an assault centre are to create opportunities to discuss professional roles and professional interests, to build up good interpersonal relations in which trust and understanding can grow, to formulate a strong and shared victim-centred vision and to support care providers with training, feedback and supervision.

Young People, Adult Worries: Randomized Controlled Trial and Feasibility Study of the Internet-Based Self-Support Method "Feel the ViBe" for Adolescents and Young Adults Exposed to Family Violence.

BACKGROUND: Adolescents and young adults (AYAs) are of special interest in a group of children exposed to family violence (FV). Past-year prevalence of exposure to FV is known to be highest in AYAs and has severe consequences. Peer support is an effective approach to behavior change and the Internet is considered suitable as a mode of delivery. OBJECTIVE: The study aimed to evaluate both effectiveness and feasibility of a randomized controlled trial (RCT) and feasibility study of the Internet-based self-support method "Feel the ViBe" (FtV) using mixed-methods approach to fully understand the strengths and weaknesses of a new intervention. METHODS: AYAs aged 12-25 years and exposed to FV were randomized in an intervention group (access to FtV + usual care) and a control group (minimally enhanced usual care) after they self-registered themselves. From June 2012 to July 2014, participants completed the Impact of Event Scale (IES) and Depression (DEP) and Anxiety (ANX) subscales of the Symptom CheckList-90-R (SCL-90) every 6 weeks. The Web Evaluation Questionnaire was completed after 12 weeks. Quantitative usage data were collected using Google analytics and content management system (CMS) logs and data files. A univariate analysis of variance (UNIANOVA) and mixed model analysis (intention-to-treat [ITT], complete case) were used to compare groups. Pre-post t tests were used to find within-group effects. Feasibility measures structurally address the findings. The CONsolidated Standards Of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth (CONSORT-EHEALTH) checklist was closely followed. RESULTS: In total, 31 out of 46 participants in the intervention group and 26 out of 47 participants in the control group started FtV. Seventeen participants (intervention: n=8, control: n=9) completed all questionnaires. Mixed model analysis showed significant differences between groups on the SCL-90 DEP (P=.04) and ANX (P=.049) subscales between 6 and 12 weeks after participation started. UNIANOVA showed no significant differences. Pre-post paired sample t tests showed significant improvements after 12 weeks for the SCL-90 DEP (P=.03) and ANX (P=.046) subscales. Reported mean Web-based time per week was 2.83 with a session time of 36 min. FtV was rated a mean 7.47 (1-10 Likert scale) with a helpfulness score of 3.16 (1-5 Likert scale). All participants felt safe. Two-thirds of the intervention participants started regular health care. CONCLUSIONS: No changes on the IES were found. SCL-90 DEP and ANX showed promising results; however, the calculated sample size was not reached (n=18). FtV functions best as a first step for adolescents and young adults in an early stage of change. FtV can be easily implemented without extensive resources and fits best in the field of public health care or national governmental care. TRIAL REGISTRATION: Netherlands National Trial Register (NTR): NTR3692; http://www.trialregister.nl/trialreg/admin/ rctview.asp?TC=3692 (Archived by WebCite at http://www.webcitation.org/6qIeKyjA4).

The need for control, safety and trust in healthcare: A qualitative study among adolescents and young adults exposed to family violence.

OBJECTIVE: Adolescents and young adults (AYA) exposed to family violence are in need of professional healthcare. However, only one-third of them seek professional help. METHODS: This study investigates healthcare needs of twelve AYA exposed to family violence. Semi-structured face-to-face interviews using purposive sampling to reach diversity. Open thematic coding was used to identify the most important themes. RESULTS: Participants experienced emotional problems, distrusted others and felt unsafe as an important consequence of their exposure to family violence. All participants expressed a need for help, but as help involved informing others, they considered it unsafe. Trust, safety and control regarding healthcare interventions emerged as vital needs. The anonymity of the Internet was considered as offering safeguards in seeking and receiving help. CONCLUSION: Trust, safety and control regarding healthcare interventions emerged as vital needs for AYA exposed to family violence. The great importance of being in control of healthcare interventions has not been reported earlier. A personal bond can lower the need for control. PRACTICE IMPLICATIONS: To comply with the three basic needs, healthcare providers should grant AYA as much control as possible while still monitoring patient safety. The Internet can be an important resource for offering low-threshold professional and peer support.

Mentor mother support for mothers experiencing intimate partner violence in family practice: A qualitative study of three different perspectives on the facilitators and barriers of implementation.

BACKGROUND: Intimate partner violence (IPV) is highly prevalent and associated with physical and mental health problems. Mentor mother support is a low threshold intervention in family practice consisting of support by non-professionals trained to support mothers experiencing IPV. A mentor mother support study showed reduced exposure to IPV and decreased symptoms of depression. OBJECTIVES: Identify factors determining implementation success of mentor mother support in family practice. METHODS: Individual interviews were conducted with 12 family physicians, 16 abused mothers and three mentor mothers. Four mentor mothers participated in a focus group. Qualitative content analysis was used to analyse the data. RESULTS: The identification and discussion of abuse is hindered by family physicians' attitudes because they considered mothers experiencing IPV as a difficult target group with a responsibility of their own to break out of their violent situation. Some family physicians doubted the partner's violence because he was known as a patient as well. Acceptance of mentor mother support is related to the readiness for change of mothers experiencing IPV. Mentor mothers facilitate acceptance and completion of their support by connecting as a friend who is equal and less threatening than professionals. CONCLUSION: To improve successful implementation of mentor mother support in primary care, we should focus on family physicians' attitudes towards IPV. To change these attitudes, we recommend continuous training of family physicians. By being paraprofessional friends, mentor mothers offer low threshold support that is complementary to professional support and should be embedded more widely in primary care. [Box: see text].

Tensions and Ambivalent Feelings: Opinions of Emergency Department Employees About the Identification and Management of Intimate Partner Violence.

The objective of this study was to examine factors facilitating and constraining the identification and management of intimate partner violence (IPV) at an emergency department (ED). Semi-structured interviews were conducted with 18 ED employees of a university hospital in the Netherlands. All interviews were audiotaped, transcribed verbatim, and analyzed by using qualitative content analysis in Atlas.ti. Constraining factors were lack of knowledge, awareness, and resources at the ED. ED employees felt many barriers to bringing up IPV. Facilitating factors were good cooperation among staff, the involvement of one team member in producing an IPV protocol, having received training on child abuse, and private consulting rooms. The ED setting and the ED employees' task perception and attitude contained both constraining and facilitating factors: ED employees saw it as their task and responsibility to help IPV victims, but their priorities were to secure a high turnover and treat acute physical problems. Although ED employees expressed openness and willingness to help, they also took the view that victims had a considerable responsibility of their own in disclosing and managing IPV, which led to ambivalent feelings. In conclusion, ED employees faced tensions in IPV identification and management caused by lack of awareness, knowledge and resources, conflicting priorities at the ED, and ambivalent feelings. Improvements can be made by supporting ED employees with guidelines in the form of a protocol and with training that also addresses the tensions ED employees face.

Are gynaecological and pregnancy-associated conditions in family practice indicators of intimate partner violence?

BACKGROUND: Some gynaecological and pregnancy-associated conditions are more common in abused women than in non-abused women, but this has not been examined in family practice. OBJECTIVE: We aimed to investigate intimate partner violence (IPV) prevalence in family practice and to investigate whether gynaecological and pregnancy-associated conditions are more common in abused women than in non-abused women. METHODS: We conducted a cross-sectional waiting room survey in 12 family practices in the Netherlands in 2012. Women were eligible if they were of 18 years or older. Questionnaires measured IPV and gynaecological and pregnancy-associated conditions. Chi-square tests were used to assess the differences in gynaecological and pregnancy-associated conditions between abused women and non-abused women. RESULTS: The response rate was 86% (262 of 306 women). The past-year prevalence of IPV in women who had had an intimate relationship in the past year and were not accompanied by their partner was 8.7% (n = 195). Lifetime prevalence of women who had ever had an intimate relationship, but not in the past year, was 17.6% (n = 51). Sexually transmitted infections (STIs) [odds ratio (OR) = 4.6, 95% confidence interval [CI] = 1.7-12.5, n = 240], menstrual disorders (OR = 3.7, 95% CI = 1.2-11.2, n = 143), sexual problems (OR = 3.3, 95% CI = 1.2-9.3, n = 229), miscarriages (OR = 2.5, 95% CI = 1.062-5.8, n = 202) and induced abortions (OR = 2.7, 95% CI = 1.028-7.3, n = 202) were significantly more common in abused women than in non-abused women. CONCLUSION: Family physicians should ask about IPV when women present with STIs, menstrual disorders, sexual problems, miscarriages or induced abortions. To improve the recognition of IPV, future research needs to investigate whether a combination of symptoms offers improved prediction of IPV.

Effectiveness of home visiting in reducing partner violence for families experiencing abuse: a systematic review.

BACKGROUND: Intimate partner violence (IPV) against women is a major, global societal problem with enormous health consequences both for mother and child. Home visiting interventions in families at risk of abuse seem promising in decreasing IPV. In this systematic review, we aim to assess the effectiveness of home visiting in reducing IPV experienced by mothers. METHODS: We conducted a systematic review using the Pubmed, PsychINFO and Embase databases from inception until March 2014, with a specific search strategy for each database. RESULTS: Of the 1258 articles identified, 19 (six different home visiting studies) met our inclusion criteria and were examined in detail. Three different types of studies were identified: the primary focus of one study was on the abused mother and the secondary focus on the children (Australia); two studies (Hawaii, The Netherlands) with a primarily focus on reduction of child abuse and a secondary focus on IPV and finally three studies from the USA, which only aimed at reducing child abuse by providing support to the mother. The Australian study reported a significant lowering of the IPV score at 1-year follow-up (15.9 versus 21.8, adjusted difference -8.67, 95% confidence interval [CI]: -16.2 to -1.15). The Hawaii-study showed significantly lower rates of physical assault after 3 years follow-up (incidence rate ratio [IRR] 0.85; 95% CI: 0.71-1.00) and the Dutch study showed a significant decrease of mothers' physical assaults 2 years after birth (odds ratio 0.46; 95% CI 0.24-0.89). The other three studies showed no significant reduction of IPV. CONCLUSIONS: Home visiting interventions that support abused women explicit to stop IPV seem to be effective in reducing IPV. However, it is not known whether these results are effective in the long term.

'I am stronger, I'm no longer afraid ', an evaluation of a home-visiting mentor mother support programme for abused women in primary care.

OBJECTIVE: We aimed to investigate which factors make a mentor mother support programme for abused women successful. METHOD: We used semi-structured interviews with abused women and focus group discussions with the mentor mothers to evaluate their experiences and needs within a mentor support programme (MeMoSA). Fourteen abused women were interviewed 6 months after the support programme ended. Mentor mothers participated in two focus group discussions. RESULTS: Abused women emphasised that nonjudgmental listening, equivalence, involvement and bonding are important factors for successful support. Mentor mothers described that empathy, availability, persistence and advocacy fitted the needs of women best to empower them and help them to cope with their violent situation at home. A safe place to meet each other was also an important factor. CONCLUSION: A good relationship, tailored support provided by home visiting, advocacy and safety are required to effectively help abused women. MeMoSA, a home-visiting support programme, is a promising valuable new support programme in primary care for abused women.

Why abused women do not seek professional help: a qualitative study.

OBJECTIVE: We aimed to gain insight into the process of help seeking of abused women visiting their family physician (FP). SETTING: Family practice in Rotterdam, the Netherlands. METHOD: We used a qualitative method with interviews in a sample of 14 abused women, identified in an earlier cross-sectional survey with the Composite Abuse Scale (CAS) and the Beck Depression Inventory (BDI). This qualitative method with semi-structured interviews was used to obtain information on the process of seeking help. RESULTS: Unawareness of the impact of abuse on themselves and their children, unfamiliarity and negative experiences with professionals and fear for their partner hampers abused women to seek professional help. Our study reveals that abused women need informal support by family and friends to ask for professional support. Current health care does not fit into the needs of abused women during the abuse they want more practical support, after the abuse they need also psychological help. In our study, FPs and mothers pay less attention to the impact of witnessing violence on children. CONCLUSION: When women are unaware of the negative consequences of IPV, the physical and mental well-being of themselves and their children they do not ask for professional support. Abused women view informal support is important in the changing process. FPs should be trained to pay more attention to informal support and be alert to children's well-being.

Support by trained mentor mothers for abused women: a promising intervention in primary care.

BACKGROUND: Intimate partner violence (IPV) against women is a major health problem and negatively affects the victim's mental and physical health. Evidence-based interventions in family practice are scarce. OBJECTIVE: We aimed to evaluate a low threshold home-visiting intervention for abused women provided by trained mentor mothers in family practice. The aim was to reduce exposure to IPV, symptoms of depression as well as to improve social support, participation in society and acceptance of mental health care. METHODS: A pre-post study of a 16-week mentoring intervention with identified abused women with children was conducted. After referral by a family doctor, a mentor mother visited the abused woman weekly. Primary outcomes are IPV assessed with the Composite Abuse Scale (CAS), depressive symptoms using the Symptom Checklist (SCL 90) and social support by the Utrecht Coping List. Secondary outcomes are analysed qualitatively: participation in society defined as employment and education and the acceptance of mental health care. RESULTS: At baseline, 63 out of 66 abused women were referred to mentor support. Forty-three participants completed the intervention programme. IPV decreased from CASt otal 46.7 (SD 24.7) to 9.0 (SD 9.1) (P ≤ 0.001) after the mentor mother support programme. Symptoms of depression decreased from 53.3 (SD 13.7) to 34.8 (SD 11.5) (P ≤ 0.001) and social support increased from 13.2 (SD 4.0) to 15.2 (SD 3.5) (P ≤ 0.001). Participation in society and the acceptance of mental health for mother and child improved. CONCLUSIONS: Sixteen weekly visits by trained mentor mothers are a promising intervention to decrease exposure to IPV and symptoms of depression, as well as to improve social support, participation in society and the acceptance of professional help for abused women and their children.

Healthcare utilization by abused women: a case control study.

BACKGROUND: Previous studies observed an association between intimate partner violence (IPV) and increased health problems. Early detection of IPV by general practitioners (GPs) is required to prevent further harm and provide appropriate support. In general practice, a limited number of studies are available on healthcare utilization of abused women. OBJECTIVES: The aim of the study was to investigate the healthcare utilization of abused women compared to non-abused. METHODS: The study was designed as a matched case-control study in 16 general practices in deprived areas in Rotterdam (The Netherlands). Electronic medical files of 50 victims of IPV were analysed for consultation frequency, referrals, medical prescription and reasons for encounter over a period of five years. Controls (n= 50) were non-abused women matched for general practice, age, number of children, and country of origin and education level. RESULTS: Abused women visited their GP almost twice as often than non-abused, in particular for social problems (OR= 3.5; 95%CI: 1.2-10.5; P= 0.01), substance abuse (OR= 4.6; 95%CI: 0.9-22.7; P= 0.05) and reproductive health problems (OR= 3.0; 95%CI: 1.3-6.8; P= 0.009). Victims of IPV were significantly more often referred for additional diagnostics (OR= 3.6; 95%CI: 1.1-12.2; P= 0.03), to mental healthcare (OR= 2.9; 95%CI: 1.2-7.1; P= 0.02) than non-victims. Abused women received 4.1 times more often a prescription for anti-depressants (95%CI: 1.5-11.6; P= 0.005) than non-abused women. CONCLUSION: As compared to non-abused women, female victims of IPV visited their GP more frequently and exhibited a typical pattern of healthcare utilization. This could alert GPs to inquire about partner abuse in the past.

Women's expectations of healthcare professionals in case of intimate partner violence in Serbia.

Women who have experienced intimate partner violence use health care services more often than non-abused women, but it is unclear what they expect from physicians in relation to their intimate partner violence experience. In this study the authors explored whether women in Serbia expect physicians to help them after having experienced intimate partner violence, what kind of help the women expected, and if none, why none is expected. The authors of this study conducted structured interviews with 120 women who visited six primary healthcare centres. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed applying content analyses. The majority of women (81.7%) expected healthcare professionals to help them in the event of intimate partner violence, mainly through giving advice, information, contacting other institutions, services, and providing understanding and support. Fewer women expected help in the form of documenting violence and contacting police. Only a minority (8.3%) did not expect help, noting that intimate partner violence is beyond the scope of healthcare professionals' interest or competencies, and/or that violence was a private problem, while 10% were unsure about the role of physicians in the case of intimate partner violence. The majority of women in this study expected help with intimate partner violence. Physicians should be aware of these expectations and how to provide support to women experiencing intimate partner violence.

Implementing mentor mothers in family practice to support abused mothers: study protocol.

BACKGROUND: Intimate partner violence is highly prevalent and mostly affects women with negative consequences for their physical and mental health. Children often witness the violence which has negative consequences for their well-being too. Care offered by family physicians is often rejected because abused women experience a too high threshold. Mentor mother support, a low threshold intervention for abused mothers in family practice, proved to be feasible and effective in Rotterdam, the Netherlands. The primary aim of this study is to investigate which factors facilitate or hinder the implementation of mentor mother support in family practice. Besides we evaluate the effect of mentor mother support in a different region. METHODS/DESIGN: An observational study with pre- and posttests will be performed. Mothers with home living children or pregnant women who are victims of intimate partner violence will be offered mentor mother support by the participating family physicians. The implementation process evaluation consists of focus groups, interviews and questionnaires. In the effect evaluation intimate partner violence, the general health of the abused mother, the mother-child relationship, social support, and acceptance of professional help will be measured twice (t = 0 and t = 6 months) by questionnaires, reporting forms, medical records and interviews with the abused mothers. Qualitative coding will be used to analyze the data from the reporting forms, medical records, focus groups, interviews, and questionnaires. Quantitative data will be analyzed with descriptive statistics, chi square test and t-test matched pairs. DISCUSSION: While other intervention studies only evaluate the feasibility and effectiveness of the intervention, our primary aim is to evaluate the implementation process and thereby investigate which factors facilitate or hinder implementation of mentor mother support in family practice.

Prevalence of intimate partner violence among migrant and native women attending general practice and the association between intimate partner violence and depression.

OBJECTIVE: To explore the prevalence of intimate partner violence (IPV) of women (aged >18 years) attending general practice and to assess the association between IPV and depression. METHODS: A cross-sectional survey was conducted within 15 general practices across Rotterdam. The study population was all women older than 18 years of age attending general practice. Women were screened for sociodemographic factors, IPV and depression using the Composite Abuse Scale and the Beck Depression Inventory. RESULTS: This study had a response rate of 63% (221 of 352 women). Two hundred and fourteen women were included in the study of whom 41% were migrants. Thirty per cent of the women attending general practise ever experienced IPV. Migrants experienced IPV 1.5 times more often compared to Dutch women. A significant association between IPV and depression was found. Half of the abused women were suffering from a depression. More than three-quarter of depressed women ever experienced IPV. CONCLUSIONS: IPV is common in women attending general practice and it is significantly associated with depression. To improve recognition of abused women, doctors should ask depressed women if they ever experienced IPV.

Prevalence of intimate partner violence at an out-patient clinic obstetrics-gynecology in the Netherlands.

Intimate partner violence (IPV) is a highly prevalent problem among women. Our aim was to investigate the prevalence of IPV among patients of an out-patient clinic obstetrics-gynecology, association with level of education, and women's opinion on asking about IPV by physicians. We conducted a survey among women between 18 and 60 years in a waiting room of an out-patient clinic obstetrics-gynecology. We used the Composite Abuse Scale to measure type and severity of IPV. Two hundred women of whom 82 (41%) were pregnant, were included in the study (response 57%). Twenty-three percent of the women ever experienced IPV and 9% currently. IPV is more prevalent among women with a lower educated partner. Four of the pregnant women (5%) experienced current IPV. Seventy-eight percent of the respondents find it important for physicians to ask about IPV. IPV proved to be a highly prevalent problem in an out-patient clinic obstetrics-gynecology with almost one-quarter of the patients ever having been victim of various forms of IPV, and almost one in 10 currently. Awareness of the possibility of IPV and early recognition by physicians might reduce mental and physical sequels and strengthen women's feeling of being supported.

The importance of gender in health problems.

OBJECTIVE: To investigate gender differences in health problems in general practice. METHODS: We performed a study using data from the Continuous Morbidity Registration (CMR) Nijmegen. To study the distribution by gender we analysed overall morbidity per 1000 patients years over a period of 10 years. Secondly we calculated the influence of gender by diagnostic rubric. For each diagnosis in the rubric of musculoskeletal disorders, we calculated incidence and sex ratio related to socio econonomic status (SES). We did the same concerning the referral rates for cardiovascular disease (CVD). RESULTS: Women had significantly more health problems than men, most striking in the age group 25-44 years, due to screening and reproductive health problems. Concerning gender differences related to SES in muskulo skeletal disorders we found the lower the SES the more prevalent is osteoarthritis of the knee in women. The sex ratios in CVD showed men as leading sufferers. Decreasing SES resulted in increasing incidence of CVD and a lower referral rate to the cardiologist in women. CONCLUSION: Sex differences appear in the prevalence of health problems, risk factors and access to medical care. They also can influence the course of diseases. Health problems in men and women also vary according to socio-economic status, meaning that gender is strongly intertwined as risk factor with socio-economic status, ethnicity, and age.

Talking matters: abused women's views on disclosure of partner abuse to the family doctor and its role in handling the abuse situation.

OBJECTIVE: We aimed to explore what women valued most in disclosing partner abuse to their doctor and whether disclosure played a role in handling their abuse situation. METHODS: A qualitative method was used to understand abused women's views and experiences with disclosure to their family doctor. Thirty-six women were interviewed within 4 weeks after disclosure to their family doctor. RESULTS: Most women went to see the doctor for some medical complaint, and only three women planned to disclose the abuse. Twenty-five women valued most their doctor's communicative approach with empathy or empowering and nine women valued most the instrumental approach. Eight women of the latter group wanted this combined with a communicative approach. After disclosure to the family doctor, a group of women (n=20) perceived a real change in their possibilities to handle their situation. They appeared to be in a position we named: 'in transition', a state in which they started or continued a process of change. Another group of women (n=13) appeared to be in a 'locked-up' position, a state without any prospect on change, feeling out of control and fearing the abuser. Three women reacted reserved towards change. CONCLUSION: A communicative approach, providing empathy and empowerment, is important to women in disclosing partner abuse. More than half of the women perceived possibilities for a change. PRACTICE IMPLICATIONS: Talking about abuse is an important step in a woman's process of change. Doctors should acknowledge the advantage of their position as a professional confidant and ask women about abuse.

Utilisation of health care by women who have suffered abuse: a descriptive study on medical records in family practice.

BACKGROUND: Female patients, abused by their partner, are heavy users of medical services. To date, valid indicators of partner abuse of women are lacking. AIM: To outline the healthcare utilisation in family practice of women who have suffered abuse, and compare this to the average female population in family practice. DESIGN OF STUDY: As part of a primary study on the role of family doctors in recognising and managing partner abuse a retrospective study was performed. Anonymised data from the electronic medical records of women who have suffered abuse were collected over the period January 2001-July 2004. These data were compared to those from the average female population of the Second Dutch National Survey in General Practice 2001 (DNSGP-2). SETTING: Family practices in Rotterdam and surrounding areas in 2004. METHOD: The numbers of consultations and prescriptions for pain medication, tranquillisers and antidepressants of women who have suffered abuse (n = 92) were compared to those of the female population of the DNSGP-2 (n = 210 071). The presented health problems and referrals of the studied group were examined. RESULTS: Pain, in all its manifestations, appeared to be the most frequently presented health problem. Compared to the female population of the DNSGP-2, in all age categories, women who have suffered abuse consult their family doctor almost twice as often and receive three to seven times more pain medication. CONCLUSION: A doubled consultation frequency, chronic pain and an excessively high number of prescriptions for pain medication are characteristics of healthcare utilisation of women have been abused in this study. These findings contribute to the development of the concept of the 'symptomatic' female patient.