Thursday, June 11, 2015

Telephonic Screening for Intimate Partner Violence? Why Not?

In the this-post-won't-go-anywhere-but-what-the-hell category, the Disease Management Care Blog was intrigued by this Annals of Internal Medicine update to the USPSTF guideline about screening women for intimate partner violence.  Basically, there is enough outcomes evidence to warrant routinely asking about it during the course of a clinic visit.

The statistics are sobering. According to the American College of Obstetrics and Gynecology, U.S. women experience 4.8 million incidents of physical or sexual assault annually and one third will experienced rape, an assault or stalking by an intimate partner in their lifetime.  One study found almost 14% of the women in the physician waiting room had recently experienced abuse. Long validated screening tools can be found here.

Despite the evidence that supports screening, the response of the medical community has been tepid.  While patient advocates may be justifiably annoyed by another example of the health care system's failure to identify and help patients in need, the docs will point out that aren't enough hours in a clinic day to address every important preventive need.

Enter population health management (PHM).  It's not clear to the DMCB that screening and referral for abuse victims has to be performed by the physician in the course of a one-on-one patient encounter.  For example, this study relied on non-physician research assistants to do the screening who, in turn, notified the physician if the screen was positive.

It's also not clear to the DMCB that screening - and possibly even referral - has to be done on a face-to-face basis.  Why not rely on other means of communication?  Studies have shown that remotely conducted surveys for and routine and not so routine health matters are a surprisingly viable and cost-effective alternative. While the stakes are obviously higher and the planning would be complex, the DMCB asks:

Why not?

The DMCB conducted a literature search and could find no published studies on the topic of using remote communication technologies (like the telephone) to screen for intimate partner violence against women.  It also suspects most of the population health management service providers do not ask about it in the course of their nurse-patient interactions.  It doubts medical homes rely on telephony, web-based technologies or remotely-based EHR technologies either.  The USPSTF is conspicuously silent on the topic.

Given the prevalence of the problem and the struggle of the traditional health care system to manage this on the usual face-to-face basis, it seems to the DMCB that this may be a problem that the PHM and PCMH community may want to explore.

Why not.

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