On Oct. 23, the U.S. Preventive Services Task Force (USPSTF) posted a final recommendation statement(www.uspreventiveservicestaskforce.org) and final evidence summary(www.uspreventiveservicestaskforce.org) on screening for intimate partner violence (IPV), elder abuse and abuse of vulnerable adults.
Based on its review of the evidence, the USPSTF recommended clinicians screen all women of reproductive age for IPV and provide or refer those who screen positive to ongoing support services that provide a range of emotional, social and behavioral support; this is a "B" recommendation.(www.uspreventiveservicestaskforce.org)
"Women experiencing intimate partner violence often don't tell others about it and don't ask for help," said task force member and family physician John Epling, M.D., M.S.Ed., in a news release.(www.uspreventiveservicestaskforce.org) "The good news is that clinicians can make a real difference for women suffering from intimate partner violence by helping to identify them and getting them the support they need."
The USPSTF said IPV is also a serious issue when perpetrated against men, but research is significantly lacking on screening and interventions for these patients. Consequently, the task force called for more research on IPV and men.
- On Oct. 23, the U.S. Preventive Services Task Force (USPSTF) posted a final recommendation statement on screening for intimate partner violence (IPV), elder abuse and abuse of vulnerable adults.
- Based on its review of the evidence, the USPSTF recommended that clinicians screen all women of reproductive age for IPV and provide or refer those who screen positive to ongoing support services that provide a range of emotional, social and behavioral support.
- Additionally, the USPSTF concluded that current evidence was insufficient to assess the balance of benefits and harms of screening for abuse and neglect in all older or vulnerable adults.
Additionally, the USPSTF concluded that current evidence was insufficient to assess the balance of benefits and harms of screening for abuse and neglect in all older (ages 60 and older) or vulnerable adults (those who are physically or mentally dysfunctional) -- an "I" recommendation.
"The task force is once again calling for more research on what works in screening for and treating elder abuse and abuse of vulnerable adults," said USPSTF member Melissa Simon, M.D., M.P.H., in the release. "Primary care clinicians should continue to use their best judgment when deciding whether to screen older and vulnerable adults and to connect those who they suspect may be experiencing abuse with resources as appropriate."
This final recommendation statement is consistent with the USPSTF's April draft recommendation statement and 2013 final recommendation statement,(www.uspreventiveservicestaskforce.org) which the AAFP supported at the time.
Final Recommendation Details
The USPSTF commissioned a systematic evidence review to update its 2013 recommendation on screening to prevent IPV, elder abuse and abuse of vulnerable adults. The scope of the current review was similar to that used for the 2013 recommendation, but for this recommendation statement, the task force also examined evidence on men and adolescents as victims of IPV.
This evidence review identified 15 fair-quality studies that assessed the accuracy of 12 screening tools for IPV. All studies enrolled adults, with most including only women or mostly women; one study included only men.
The studies reviewed recruited participants from a variety of settings: five recruited from emergency departments, four from primary care practices, one from urgent care, and three recruited women by telephone or mail survey.
Most of the studies assessed a tool designed to identify patients exposed to IPV in the past year.
"However, four studies reported on the accuracy of five tools for identifying current (ongoing) abuse, one assessed the accuracy of detecting lifetime abuse and one assessed the accuracy of a tool for predicting future (within three to five months) abuse," the recommendation noted.
Five studies evaluated the accuracy of five screening instruments in detecting IPV during the past year in adult women:
- Humiliation, Afraid, Rape, Kick;
- Extended Hurt/Insult/Threaten/Scream;
- Partner Violence Screen; and
- Woman Abuse Screening Tool.
Sensitivity for those tools ranged from 64 percent to 87 percent, and specificity ranged from 80 percent to 95 percent.
Four studies reported on the accuracy of five screening tools for identifying ongoing or current abuse. Sensitivity across those tools ranged from 46 percent to 94 percent; specificity ranged from 38 percent to 95 percent.
Response to Public Comment
The draft version of this recommendation statement was posted for public comment on the USPSTF website from April 24 to May 21.
Some commenters asked for more details about the patient population examined, including whether men and older women were included in the recommendation. In response, the USPSTF clarified that it examined the evidence on the benefits and harms of screening for IPV in women of all ages and in men, with the recommendation being based on available evidence.
Other commenters suggested screening instruments for elder abuse for inclusion. After reviewing those tools, however, none of the suggested instruments met the USPSTF's inclusion criteria (e.g., the screening tools were developed or tested in populations with recognized signs or symptoms of abuse).
The USPSTF noted the types of screening instruments that are needed for further study in its Other Considerations section,(www.uspreventiveservicestaskforce.org) along with suggested resources for clinicians to use.
The AAFP's Commission on Health of the Public and Science plans to review the USPSTF's final recommendation statement and evidence review and determine the Academy's stance on the recommendation.
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