New Guidelines Encourage Regular Screening for Intimate Partner Violence
Physicians are prompted to screen for signs of abuse in female patients, both to improve diagnosis and treatment—and lower healthcare costs.
--by Joann Jovinelly
The evidence is alarming. According to the Centers for Disease Control and Prevention (CDC), more than 35 percent of American women are raped, assaulted, or stalked at some point in their lives. Nearly one third of U.S. women say they are “fearful” of their partner.
Intimate partner violence (IPV) affects women throughout their lives, not only increasing their risk of bodily injury, but also putting them at increased risk for gastrointestinal disorders, chronic pain, gynecological problems, hypertension, and depression. Intimate partner violence also massively increases healthcare costs in the long run.
Despite the staggering statistics, there are no national guidelines in place for physicians who may attempt to offer support or services to abused patients as part of their treatment.
That is about to change.
As of August 2012, new guidelines under President Obama’s Affordable Care Act now require insurance companies to cover screening and counseling for IPV as part of eight essential healthcare services for women. And this month’s New England Journal of Medicine takes on the issue, offering sound advice for clinicians on how to be more proactive without further endangering their patients.
Among those changes is a recommendation to all primary care physicians to regularly screen their female patients 12 years and older for signs of abuse. One of the methods recommends gently beginning a dialogue by asking, "Are you afraid of your partner or anyone else?"
The Expert Take
Sharon Horesh-Bergquist, M.D., assistant professor of medicine at Emory University School of Medicine in Atlanta, Georgia, says that increased screening of her patients for signs of IPV has helped them.
“I can say that for at least some of the patients, asking those questions opened the window to more services, more accurate diagnosis of chronic issues, and better management of their health,” said Horesh-Bergquist.
With more than one in three girls and women the target of abuse in the United States, it seems practical and worthwhile to make screening for IPV a part of every wellness check-up. Not only do the recommendations have the potential to save lives, but the chronic injuries brought on by IPV that add to our nation’s skyrocketing healthcare costs may be vastly reduced with ongoing and consistent intervention.
A 2012 study published in the Annals of Internal Medicine noted 5.3 million American women were the victims of violence each year. In that study, regular screenings by physicians led to a 36 percent increase in transparency, opening up a much-needed dialogue about domestic abuse.
Earlier, in 2005, a study published in Women’s Health Issues noted that average HMO healthcare costs in women who reported IPV in a three-year period were an average of $1,700 greater than those in the control group.
In that report, study authors concluded that “intimate partner violence elevates healthcare costs, not only among women currently experiencing abuse, but also among women for whom the abuse has ceased.”
Finally, a 2002 study published in The Lancet discussed both immediate and long-term conditions experienced by victims of abuse, including chronic migraine, neurologic disorders, post traumatic stress syndrome, depression, unwanted pregnancies, sexually transmitted disease, and a host of other gastrointestinal and gynecological problems.