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Intimate partner violence and women veterans: the need for a standardized response.
Dichter ME, Marcus SC. Intimate partner violence and women veterans: the need for a standardized response. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 18; National Harbor, MD.
Intimate partner violence (IPV) is a major source of morbidity and mortality for women, and contributes to homelessness, unemployment, and suicide. Nationally, a third of women Veterans report having experienced actual or threatened physical or sexual violence from a current or former intimate partner. VHA lags behind other healthcare systems in implementing recommended standard protocols for identifying and responding to IPV. The objectives of this study were: to identify rates of IPV in women Veterans as documented in medical records; to explore associations between documented IPV and patient demographic, military experience, and clinical characteristics; and to assess the current quality of IPV documentation compared with national standards.
We conducted a retrospective chart review of women Veterans who had visited the Philadelphia VAMC Women's Health Clinic in 2009. We collected data on patient demographic and clinical characteristics from the VISN4 Data Warehouse and reviewed every progress note for all visit types over a five-year time period (2005-2009) for a sample of women Veterans aged 55 and younger.
Of the 533 patient charts reviewed, 108 contained specific reference to IPV victimization and an additional 18 contained reference to possible IPV, for a total of 126 (23.6%). We found no statistically significant differences between patients with and without documented IPV in demographic or military service characteristics. Documented IPV was associated with diagnoses of infectious diseases, endocrine/nutritional/metabolic and immunity disorders, digestive system disorders, military sexual trauma, and mood disorders, alcohol/drug use, sleep problems, and PTSD. Among those with documented IPV, adult physical or sexual abuse/rape was included in diagnosis codes in only 9% of charts. Thematic analysis of provider notes reflected a lack of standard protocol in identifying, responding to, and documenting IPV.
Women Veterans who have experienced IPV have an extensive range of health concerns. Practices with regard to IPV assessment and response, as documented in VHA patients' medical records, do not reflect current standards of care for addressing IPV in the healthcare setting.
To better serve women Veterans, VHA providers should assess for IPV victimization, document related issues and disclosures, and offer care as consistent with expert guidelines.