Experience of intimate partner violence (IPV) is a major health concern associated with multiple adverse physical and psychosocial health outcomes, particularly for women, and women veterans experience especially high risk of IPV exposure. Healthcare systems may mitigate these effects through detection and provision of supportive services to assist patients in recovering from IPV experience and seeking safety from future violence. In 2013, VHA approved plans to implement an IPV screening and assistance program that would be the largest national healthcare-based IPV identification and response program in the country. A substantial body of literature reports on studies of IPV screening and patient disclosure in healthcare settings; however, we know little about patients' experiences and health outcomes following disclosure.
Study objectives are to identify the population in need of IPV-related care in VHA, disparities in care or outcomes, and services or supports most helpful in improving patients' safety and well-being. Specific aims are to identify: 1) the rate at which female VHA patients screen positive for past-year IPV and access VHA IPV services, and the demographic and clinical characteristics associated with both outcomes; 2) patient health and safety following disclosure of past-year IPV, and associations with service use and safety-related empowerment; and 3) patients' experiences with violence and service access, and perspectives on how interventions impact their health and safety.
Aim 1: We extracted data from the VHA Corporate Data Warehouse for all female patients who completed IPV screening via a clinical reminder between April, 2014 to April, 2016. We identified the rate of positive IPV (IPV+) screens and examined associations with demographic, clinical, and health services use characteristics. We reviewed electronic health records (EHR) of patients screening IPV+ at select sites to assess referral to and utilization of IPV assistance services.
Aim 2: We enrolled patients (N=169) who disclosed experience of past-year IPV at two sites to complete structured interviews at baseline and follow-up (6-9 months post-baseline); interviews measured experience of violence, safety behaviors, service use/help-seeking, empowerment, and health outcomes. We also reviewed EHR for this sample to supplement primary data.
Aim 3: We conducted in-depth qualitative interviews with a subset (N=50) of patients enrolled in Aim 2 to understand patient experiences and perspectives regarding services and needs.
Of the 8,888 patients in the Aim 1 cohort, 8.7% screened positive for past-year IPV (IPV+), with higher rates among younger and married women, non-Veterans, and those who had experienced military sexual trauma. Screening IPV+ was also associated with higher odds of mental health diagnoses, suicidal ideation/behavior, and increased healthcare service utilization. Based on EHR review at 2 sites, nearly 20% of IPV+ cases had no documented follow-up. Receipt of services to address IPV is associated with increased perception of empowerment and can reduce feelings of isolation that contribute to suicidal ideation.
Study findings are reported back to the VA National IPV Assistance Program and other relevant offices to inform IPV programming projections and protocols regarding screening and intervention. Findings support expansion of high-quality routine inquiry about IPV exposure, patient-centered care that recognizes and validates individual self-determination around choices related to IPV and service utilization, and connections with IPV services for patients in need and between programs (e.g., with suicide prevention, homelessness services, mental health, and MST services). IPV assessment and services should not be limited by patient age, Veteran status, or relationship status. Additional findings from analysis of the data not specific to the original study aims also find support for engaging women Veterans in IPV-related research.
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Intimate Partner Violence, Outcomes - Patient, Utilization