Genitourinary medicine clinic policies on domestic violence across England and Wales: a postal questionnaire survey

INTRODUCTION

Domestic violence (DV) affects one in four women in the UK. ^1,2 There are limited published data on the prevalence of DV in genitourinary (GU) medicine clinic settings. ³ There are no national recommendations for assessing DV within GU medicine. With this in mind, we carried out a questionnaire survey across England and Wales to assess clinic policies and referral pathways around DV. This survey also determined views on routine assessment of DV within GU medicine.

METHODS

A postal questionnaire was sent to all GU medicine clinics across England and Wales during July 2009 from the Audit Department at Royal Bournemouth Hospital.

Contact details for GU medicine clinics were obtained from British Association of Sexual Health and HIV (BASHH) website and Association for GU medicine archive. The questionnaire was addressed to a health adviser or senior nurse/consultant. Non-respondents were telephoned after three months of the initial mail out. Information received was kept confidential.

Data were gathered on: whether clinics routinely asked patients about DV; staff training on DV; patients’ access to DV information; existing clinic policies on identifying victims of DV; thoughts on routine assessment of DV and best setting to screen for DV. An area was left for any related comments. Data were analysed using Microsoft Excel.

RESULTS

Fifty-three percent (126/238) of surveys were returned. Respondents were health advisers (79%), senior nurse specialists (13%), nurse clinic managers (3%) and consultants (5%). Only 11% (14/126) of clinics routinely asked patients about DV and they were from inner city clinics clustered within London and south-east England. Almost half the clinics (49% [62/126]) had staff awareness training on DV. The vast majority of services (85% [107/126]) had access to patient information leaflets. Only 20% (25/126) of clinics had guidelines to signpost patients on to the appropriate service once they disclosed DV. Just over half of clinics who responded (54% [68/126]) agreed that DV should be assessed in a GU medicine setting (see Figure 1). Thirty-eight percent of consultants agreed with DV assessment in GU medicine setting compared with 55% of nurses.

OPEN IN VIEWER

Figure 1

Survey responses to: ‘Should we routinely ask patients for domestic violence in a genitourinary medicine setting?’

When asked about alternative settings, primary care was the most popular answer followed by the emergency department and antenatal clinics (see Figure 2).

OPEN IN VIEWER

Figure 2

Survey responses to: ‘Where should domestic violence be assessed if not in the genitourinary medicine clinic?’ Other included police, support agencies, social worker and anywhere

The majority of respondents (66% [83/126]) felt that DV should be addressed at any point where the patient contacted medical services. The routine assessment within GU medicine was felt a ‘bit excessive’ for 10% (12/126) of respondents.

DISCUSSION

DV is a serious and widespread issue throughout the UK. ^1,2 It is associated with sexual abuse and rape. ⁴ Victims of DV have higher rates of sexual health problems, such as chronic pelvic pain and increased incidence of sexually transmitted infections. ⁵ The Department of Health (DoH) handbook 2006 states that ‘all Trusts should be working towards routine enquiry and providing women with information on domestic abuse support services’. There are no current BASHH guidelines on DV. GU medicine clinics could be an ideal opportunity to confide and seek assistance.

In this study, over 50% of respondents agreed that routine assessment for DV should happen in GU medicine but only 11% clinics routinely asked about DV. Those clinics which routinely screened for DV were clustered around London and south-east England. Most clinics had access to patient information, which is recommended in the DoH handbook. This is of importance for patients who do not disclose or for clinics where routine DV assessment is unavailable due to time constraints. Many comments were around service commitment and DV assessment in GU medicine. GU medicine staff will often search for and ask patients suitable questions to highlight other types of abuse, so a GU medicine visit may be an appropriate time to enquire about DV.

As a result of this limited survey, we would like to propose these recommendations:

All clinics should have patient-visible literature on DV;