2 - (SYM 37) Examining Physician Responses to Positive Intimate Partner Violence (IPV) Screening in Primary Care Using an Electronic Health Record Facilitated Confidential Encounter Template

Background: IPV is a major public health problem. Effectively responding to IPV disclosure and referring to evidence-based care to mitigate adverse outcomes is critical. We describe the embedding of a confidential clinician electronic health record (EHR) encounter template for IPV primary care screening, as well as physician brief interventions for positive (+) screens.

Methods: We developed an EHR intervention for IPV screening and documentation of results, brief intervention, and treatment referral in southeastern U.S. primary care clinics. The parent project employed a randomized, stepped wedge study design in 15 clinics. Data represent 132 women screening + for IPV (55.30% White; 39.39% Black or African American; 93.94% Non-Hispanic; 70.45% aged 20-39), relative to 8895 patients. The EHR encounter template embedding process included clinic staff meetings, template implementation, tailored assessment results, and referral options. The IPV screening process included a three-item Partner Violence Screen (PVS), the Danger Assessment-5 (DA-5) for + PVS screens, best practice advisory, and physician template.

Results: There was variable data missingness. 43.94% scored ≥ 2 on the DA-5, suggesting elevated risk for lethal IPV. In 73 + screens, physical exams were performed on 34 patients (46.58%). Physical exams were not performed (31.51%) for various reasons (e.g., service connected), or were declined (21.92%). In the same 73 patients offered a hotline referral, connection to a national IPV hotline was placed for 5 (6.85%) with others declining (63.01%). Some hotline referrals were not made (e.g., patient reports feeling safe with no imminent danger; 30.14%). In documentation for 75 patients, providers described IPV details and impact (n = 48) and interventions offered (n = 19) or clarified patient screeners. Common codes were Adult Physical Abuse, Confirmed (47.46%) or Counseling on Injury Prevention (52.54%). There were no associations between DA-5 and offer of hotline referral or performing physical exams (ps > .05). Average DA-5 for those accepting a referral = 1.8. Neither age nor race were associated with hotline referral offer (ps > .05).

Discussion: Results provide information on physician IPV responses and processes of embedding an EHR IPV tool, which provides an opportunity to enhance reach and impact of cognitive behavioral therapies in those with care barriers in primary care settings. Standardized guidelines for IPV documentation and innovations to assist providers in IPV response may improve uptake and service adoption.