How far does screening women for domestic (partner) - NIHR Health ...

DOI: 10.3310/hta13160 Health Technology Assessment 2009; Vol. 13: No. 16
The issue of whether the test is acceptable to the
public is addressed in question III, albeit only from
the perspective of women. We did not address the
issue of whether the programme is acceptable to
male members of the general public.
Specific review questions:
• Is screening for partner violence generally
acceptable to health professionals?
• Do health professionals’ views about screening
differ as a function of previous experience of
screening?
• Do health professionals’ views about screening
differ as a function of their role (e.g. physician,
nurse, psychiatrist) or the setting in which they
work (e.g. family practice, A&E, antenatal,
dental practice)?
• Are there any other factors associated with
acceptability/non-acceptability?
– age and ethnicity
– training on partner violence.
Question VII: Is screening
for partner violence
cost-effective?
NSC criterion 16: The opportunity cost of the
screening programme (including testing, diagnosis,
treatment, administration, training and quality
assurance) should be economically balanced in
relation to expenditure on medical care as a whole
(i.e. value for money)
We reviewed studies evaluating the costeffectiveness
of screening. We complemented this
with a cost-effectiveness model based on a pilot
study of a primary care-based intervention that
aimed to improve the identification of women
patients experiencing partner violence.
NSC criteria not addressed
by this review
NSC criterion 2: The epidemiology and natural history
of the condition, including development from latent
to declared disease, should be adequately understood
and there should be a detectable risk factor, disease
marker, latent period or early symptomatic stage
We did not address this criterion because of its
problematic application to the issue of partner
violence: partner violence is not a condition in the
disease model sense, and screening is not limited
to detection of early stages of abuse.
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NSC criterion 3: All the cost-effective primary
prevention interventions should have been
implemented as far as practicable
In terms of partner violence, primary prevention
interventions are largely in educational and media
settings and we did not review these. This criterion
is not relevant to a decision to implement a
screening programme in health-care settings.
Review of evidence for criteria 8, 9 and 12 were
part of our original proposal. Below we explain why
we did not include them in the final review.
NSC criterion 8: There should be an agreed policy
on the further diagnostic investigation of individuals
with a positive test result and on the choices available
to those individuals
Further ‘diagnostic investigation’ is not relevant to
the care of women who are identified in partner
violence screening programmes.
NSC criterion 9: There should be agreed evidencebased
policies covering which individuals should be
offered treatment and the choices available to those
individuals
Although some primary studies in our review
discussed choices available to women disclosing
abuse, there are no ‘evidenced-based policies’ for
these treatment choices and, in the context of our
resources for the reviews, we judged this criterion
of secondary importance compared with those we
did review.
The following criteria need to based on audit and
policy research. They only need to be considered
once the evidence-based criteria are met:
NSC criterion 12: Clinical management of
the condition and patient outcomes should be
optimised by all health-care providers prior to
participation in a screening programme.
NSC criterion 17: There should be a plan
for managing and monitoring the screening
programme and an agreed set of quality assurance
standards.
NSC criterion 18: Adequate staffing and facilities
for testing, diagnosis, treatment and programme
management should be available prior to the
commencement of the screening programme.
NSC criterion 19: All other options for managing
the condition should have been considered (e.g.
improving treatment, providing other services),
to ensure that no more cost effective intervention
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