It is unknown whether interventions known to improve the healthcare response to domestic violence and abuse (DVA)—a global health concern—are effective outside of a trial. An observational interrupted time series study in general practice. All registered women aged 16 and above were eligible for inclusion. In four implementation boroughs’ general practices, there was face-to-face, practice-based, clinically relevant DVA training, a prompt in the electronic medical record, reminding clinicians to consider DVA, a simple referral pathway to a named advocate, ensuring direct access for women to specialist services, overseen by a national, health-focused DVA organisation, fostering best practice. The fifth comparator borough had only a session delivered by a local DVA specialist agency at community venues conveying information to clinicians. The primary outcome was the daily number of referrals received by DVA workers per 1000 women registered in a general practice, from 205 general practices, in all five northeast London boroughs. The secondary outcome was recorded new DVA cases in the electronic medical record in two boroughs. Data was analysed using an interrupted time series with a mixed effects Poisson regression model. In the 144 general practices in the four implementation boroughs, there was a significant increase in referrals received by DVA workers—global incidence rate ratio of 30.24 (95% CI 20.55 to 44.77, p < 0.001). There was no increase in the 61 general practices in the other comparator borough (incidence rate ratio of 0.95, 95% CI 0.13 to 6.84, p = 0.959). New DVA cases recorded significantly increased with an incident rate ratio of 1.27 (95% CI 1.09 to 1.48, p < 0.002) in the implementation borough but not in the comparator borough (incidence rate ratio of 1.05, 95% CI 0.82 to 1.34, p = 0.699). Implementing integrated referral routes, training and system-level support, guided by a national health-focused DVA organisation, outside of a trial setting, was effective and sustainable at scale, over four years (2012 to 2017) increasing referrals to DVA workers and new DVA cases recorded in electronic medical records.

中文翻译：

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改善英国初级保健中对家庭暴力和虐待的医疗保健反应：中断对系统级培训和支持计划的时间序列评估。

尚不清楚已知的改善医疗保健对家庭暴力和虐待（DVA）的干预措施（全球健康问题）在试验之外是否有效。一般实践中的观察性中断时间序列研究。所有16岁及以上的注册女性都有资格被纳入。在四个实施区的一般实践中，进行了面对面，基于实践的临床相关DVA培训，电子病历中有提示，提醒临床医生考虑DVA，这是向指定代言人的简单推荐途径，确保直接在国家重点关注健康的DVA组织的监督下，妇女获得专门服务的机会，从而促进了最佳做法。第五个比较区自治市镇只有一个DVA专业机构在社区场所举行的会议，将信息传达给临床医生。主要结果是伦敦东北部所有五个区的DVA工人每天从每205名普通医生中登记的每1000名普通医生收到的推荐转诊数。次要结果是在两个行政区的电子病历中记录了新的DVA病例。使用具有混合效应Poisson回归模型的中断时间序列分析数据。在四个实施行政区的144个常规操作中，DVA工人收到的推荐信数量显着增加，全球发生率30.24（95％CI 20.55至44.77，p <0.001）。其他比较自治市镇的61种常规做法没有增加（发生率比率为0.95，95％CI为0.13至6.84，p = 0.959）。记录的新DVA病例显着增加，发生率为1.27（95％CI为1.09至1.48，p <0.002）在实施自治市镇，但不在比较自治市镇（发生率比为1.05，95％CI为0.82至1.34，p = 0.699）。在试验环境之外，在以国家卫生为重点的DVA组织的指导下，实施综合的转诊路线，培训和系统级支持在四年（2012年至2017年）内有效且可持续地大规模实施，并且持续了四年（2012年至2017年），增加了对DVA工人和新人的转诊DVA案件记录在电子病历中。