In 2001 the New Zealand Ministry of Health launched abest-practice guideline recommending all female general practice patients sixteen years and over be routinely screened for physical and sexual abuse by their partners. I reviewed the evidence as to whether this met internationally-recognised criteria for screening:
- availability of a clear diagnosis
- suitable validated screening test
- acceptability of routine screening by patients and health providers
- benefits of earlier detection and application of appropriate interventions to prevent the progression of a disorder, and hence reduction in incidence of morbidity and mortality
- identification of possible harm from screening (from false positives, false negatives, adverse effects of labelling, early diagnosis or unnecessary treatment of persons with true-positive test results with inconsequential disease)
- weighing this against potential benefits
- identification of possible sub-populations with the possibility of targeted screening of high-risk populations
- good quality evidence of interventions effective in preventing or managing the disorder
- cost-effectiveness assay
The existing research indicated that screening of women for domestic violence by their male partners did not meet these criteria and therefore routine screening of adult women for partner abuse could not be justified.
This led to several publications:
Screening for domestic violence in general practice: A way forward?
Goodyear-Smith F, Arroll B. British Journal of General Practice, 53 (492) 515-518, 2003
Screening for domestic violence: authors’ response
Goodyear-Smith F, Arroll B Letter to the Editor. British Journal of General Practice, 53 (10): 810, 2003 (Comment in: Br J Gen Pract. 2003 Oct;53(495):809-10; author reply 810; PMID: 14601362)
National screening policies in general practice: a case study of routine screening for partner abuse
Goodyear-Smith F Applied Health Economics and Health Policy,1 (4): 197-209, 2002
Abstract
Internationally-recognised criteria for screening for a particular disorder require the following: availability of a clear diagnosis; a suitable validated screening test; acceptability of routine screening by patients and health providers; benefits of earlier detection and application of appropriate interventions to prevent the progression of a disorder, and hence reduction in incidence of morbidity and mortality; identification of possible harm from screening (false positives, false negatives, adverse effects of labelling, early diagnosis or unnecessary treatment of persons with true-positive test results with inconsequential disease) and weighing this against potential benefits; identification of possible sub-populations with the possibility of targeted screening of high-risk populations; good quality evidence of interventions effective in preventing or managing the disorder; and a cost-effectiveness assay. The New Zealand Ministry of Health have launched a best-practice guideline recommending all female general practice patients sixteen years and over be routinely screened for physical and sexual abuse by their partners. Inter-partner violence, especially against women by male partners and expartners, is a serious public health problem. However, review of existing research indicates that this guideline meets none of the criteria listed above. Considerable funding is invested in training health providers to implement this screening protocol, but, in the absence of effectiveness studies, cost-effectiveness cannot be assessed. Under current conditions, routine screening of adult women for partner abuse cannot be justified. However, GPs should be encouraged to learn about partner abuse and consider this possibility in patients presenting with physical injuries, psychological disturbance or social dysfunction, especially in high-risk patients. Research should be supported for the development and validation of effective, acceptable screening tools and randomised controlled trials of appropriate interventions. The desire to intervene for the public good should not dictate the implementation of a screening programme that disregards accepted screening criteria.
Invited commentary on Medical Management of Intimate Partner Violence Considering the Stages of Change: Precontemplation and Contemplation: Routine screening for intimate partner violence – an alternative perspective
Goodyear-Smith F. Annals of Family Medicine, 2: 231-239, 2004