Many primary care physicians in rural communities do not routinely screen women for intimate partner violence (IPV), according to Penn State medical and public health researchers. Rural women who are exposed to such violence have limited resources if they seek help.
"Rural health care providers are uniquely positioned to help women," said Jennifer S. McCall-Hosenfeld, a primary care physician and assistant professor of medicine and public health sciences, Penn State College of Medicine. "However, in rural settings, it might be even more important for physicians to step in, because there are few places for women experiencing IPV to turn. The physicians are in a good position to help, and may be the only option for rural women."
The researchers interviewed 19 primary care physicians who provide care to rural women in central Pennsylvania. The physicians answered questions that focused on IPV screening, perceptions of IPV as a health problem, current practices for responding to identified IPV and barriers unique to rural communities that affect care for women who have experienced IPV. McCall-Hosenfeld and her colleagues report their findings online and in the current issue of the Journal of Interpersonal Violence.
Only six of the physicians interviewed screened women for IPV, and within that group there was no standardized interval for screening. Seven participants did not think routinely screening every female patient for IPV was necessary.
"I don't think it's appropriate unless there's something to suggest it might be happening ... We have a lot of patients who come in and are happy, healthy, well-adjusted, and I'm not going to ask those if they're getting beaten on," explained one physician during the interview.
Nearly half of the physicians acknowledged that financial dependence on the abuser was a barrier for many women who might otherwise seek help for IPV. Eleven percent of the physicians also pointed out that patients may not even consider their family doctor as the person to go to for help.
"Patients often don't think of IPV as a health problem," said McCall-Hosenfeld, another barrier several physicians identified.
The United States Preventive Services Task Force now recommends IPV screening.
"IPV identification and treatment in primary care settings will also likely increase as a consequence of the Patient Protection and Affordable Care Act of 2010, as screening and counseling for domestic violence has been added as a primary preventive service that all private health plans must cover," the researchers wrote.
The researchers believe that women suffering violence in rural areas would be helped by providing training for PCPs, educating the community and improving access to referral services. McCall-Hosenfeld and colleagues note that future research should address both strategies to support PCPs' care of rural women as well as rural women's expectations and preferences for getting help within their communities.
Also working on this research were Carol S. Weisman, Distinguished Professor of Public Health Sciences and Obstetrics and Gynecology, and Cynthia H. Chuang, associate professor of medicine and public health sciences, both at the College of Medicine; and Marianne H. Hillemeier, professor of health policy and administration and demography, and Amanda N. Perry, graduate student in rural sociology.
The Penn State Clinical and Translational Sciences Institute and the Penn State Building Interdisciplinary Research Careers on Women's Health Program, supported by National Institutes of Health's Eunice Kennedy Shriver National Institute of Child Health and Human Development, supported this research.
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