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Primary care Identification and Referral to Improve Safety of women experiencing domestic violence: a randomised controlled trial
ISRCTN ISRCTN74012786
DOI 10.1186/ISRCTN74012786
ClinicalTrials.gov identifier
EudraCT number
Public title Primary care Identification and Referral to Improve Safety of women experiencing domestic violence: a randomised controlled trial
Scientific title
Acronym IRIS
Serial number at source 1
Study hypothesis Will a training and support programme for general practices increase the identification and referral to domestic violence agencies of women survivors of domestic violence?
Lay summary Not provided at time of registration
Ethics approval Ethics approval received from the NHS National Research Ethics Service - South East Research Ethics Committee on the 27th July 2007 (ref: 07/MRE01/65).
Study design Cluster randomised controlled trial; unit of randomisation is practices.
Countries of recruitment United Kingdom
Disease/condition/study domain Domestic violence referrals in General Practices
Participants - inclusion criteria General practices within City and Hackney or Bristol Primary Care Trust (PCT) if they record consultations electronically and their systems allow the use of screen prompts.
Participants - exclusion criteria Practices will be excluded if:
1. They do not use electronic medical records
2. Their systems do not allow the use of screen prompts
3. They have already had significant training in identification of women experiencing domestic violence and established a referral pathway to an advocacy service
Anticipated start date 01/07/2007
Anticipated end date 30/06/2010
Status of trial Completed
Patient information material
Target number of participants 48 practices (24 in Hackney and 24 in Bristol)
Interventions Practices in Hackney and Bristol will be randomly allocated to the intervention and control group.

Intervention:
The intervention is designed to address the barriers to making a general practice domestic violence "competent" and improves the quality of care for survivors of abuse. This will entail two 2-hour multi-disciplinary training sessions with clinicians using case studies and role-play in relation to asking about violence and responding appropriately.

This will be followed by periodic reinforcement sessions feeding back practice data on disclosure and referral and encouraging discussion about improving the quality of care. The clinicians include General Practitioners (GPs) and directly employed practice staff (practice nurses and counsellors) and those employed by trusts (midwives, health visitors, district nurses). We will also engage administrative staff in a session that will highlight their role in data handling and confidentiality.

Feedback of anonymous disclosure and referral data can be done at practice meetings at which the program would be a regular agenda item. In each intervention practice we will identify a "champion" for the project. They can be from any of the clinical disciplines and will have the agreement of the practice to attend additional training about domestic violence and integrating this into the work of the practice. The advocate-educator will, in conjunction with the practice champion, meet with smaller groups of clinicians to address problems that have arisen around identification, support and referral.

Control:
The control group is made up of 12 general practices in Bristol and 12 in London.

The educational and support intervention will be continuous over the year of follow-up from first educational session. Intervention and control practices will be followed up for one year.
Primary outcome measure(s) Recording in the medical record identification of women who have experienced or are experiencing domestic violence, measured at 3 months, 6 months, 9 months and one year.
Secondary outcome measure(s) 1. Referral of women who have experienced or are experiencing domestic violence to specialist domestic violence agencies and/or practice based counselling
2. Knowledge, beliefs, and practices of health care professionals with regards to domestic violence (Physician REadiness to Manage Intimate partner violence Survey [PREMIS] questionnaire to participating clinicians)
3. Expectations and experiences of clinicians targeted by the intervention (interviews with purposive sample of clinicians in intervention practices

All secondary outcomes will be measured at 3 months, 6 months, 9 months and one year.
Sources of funding The Health Foundation (UK) (ref: 6421/4601)
Trial website
Publications 1. 2010 protocol in: http://www.ncbi.nlm.nih.gov/pubmed/20122266
2. 2011 results in http://www.ncbi.nlm.nih.gov/pubmed/22000683
Contact name Prof  Gene  Feder
  Address Community Based Medicine
25/27 Belgrave Road
Clifton
  City/town Bristol
  Zip/Postcode BS8 2AA
  Country United Kingdom
Sponsor The Health Foundation (UK)
  Address 90 Long Acre
  City/town London
  Zip/Postcode WC2E 9RA
  Country United Kingdom
  Sponsor website: http://www.health.org.uk
Date applied 21/05/2007
Last edited 20/12/2011
Date ISRCTN assigned 27/09/2007
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