Organization-Based Factors Bearing on Provider Screening and Referral Practices for Women Exposed to Intimate Partner Violence.

Essential steps in the provision of health care for women exposed to intimate partner violence (IPV) are screening and referral for specialized services, as might occur in primary care settings. Prior to participating in a cross-disciplinary IPV training program, medical care (N = 223) and social/behavioral practitioners (N = 197) completed a survey that ascertained current practices, provisions, and perceived barriers related to IPV screening and referral. Roughly half of the study participants did not routinely screen their patients/clients for IPV, with no differences for the professional groupings. Utilization of referral resources was significantly lower for medical care providers, 78.5% of whom did not use any. Perceived barriers to screening and referral were examined as practitioner-based and organization-based, and we identified tangible provisions (protocols and practice materials) as a relevant variable. As we conjectured, organization-based barriers were more strongly associated with lower rates of screening and referral than were practitioner-based barriers, regardless of professional grouping. Moreover, tangible provisions, controlling for perceived barriers, significantly added to routine screening and frequency of referral resources usage, particularly for medical care providers. Results are discussed in the context of a systems-level approach to improving IPV services in health care with organizational practice enhancements.

Depression during pregnancy and postpartum.

Postpartum depression is the most common complication of pregnancy, affecting 10% to 15% of women. This condition continues to be underdiagnosed and undertreated despite increased awareness. Several risk factors have been identified including anxiety or depression during pregnancy, a history of depression, as well as increased life stressors. Treatment for depression has been found to be effective and generally safe during pregnancy and while breastfeeding. The risks and benefits of treatment must be carefully evaluated and balanced with the risk of no treatment. Careful screening may assist physicians for more timely diagnosis and intervention.

Domestic violence and rape.

No compilation of women's health care is complete without confronting domestic violence and sexual assault. Long recognized as a health care and physician issue, intimate partner violence continues to be one of the most frequent causes for injury and death to women in the United States and worldwide. According to the Commonwealth Fund survey in 1998, 31% of women reported either physical or sexual abuse from a husband or boyfriend. One in five American women also reported being raped during their lifetime. Careful assessment and universal screening are important tools for the primary care physician.