scholarly journals Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation

2020 ◽  
Author(s):  
Jasmina Panovska-Griffiths ◽  
Alex Hardip Sohal ◽  
Peter Martin ◽  
Estela Barbosa Capelas ◽  
Medina Johnson ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Time Series ◽  
Service Providers ◽  
Interrupted Time Series ◽  
Referral Rate ◽  
System Level ◽  
Health Concern ◽  
Service Disruption ◽  
The Impact ◽  
Domestic Violence And Abuse

Abstract Background Domestic violence and abuse (DVA) is experienced by about 1/3 of women globally and remains a major health concern worldwide. IRIS (Identification and Referral to Improve Safety of women affected by DVA) is a complex, system-level, training and support programme, designed to improve the primary healthcare response to DVA. Following a successful trial in England, since 2011 IRIS has been implemented in eleven London boroughs. In two boroughs the service was disrupted temporarily. This study evaluates the impact of that service disruption.Methods We used anonymised data on daily referrals received by DVA service providers from general practices in two IRIS implementation boroughs that had service disruption for a period of time (six and three months). In line with previous work we refer to these as boroughs B and C. The primary outcome was the number of daily referrals received by the DVA service provider across each borough over 48 months (March 2013-April 2017) in borough B and 42 months (October 2013-April 2017) in borough C. The data were analysed using interrupted-time series, non-linear regression with sensitivity analyses exploring different regression models. Incidence Rate Ratio (IRR), 95% confidence intervals and p-values associated with the disruption were reported for each borough.Results A mixed-effects negative binomial regression was the best fit model to the data. In borough B, the disruption, lasted for about six months, reducing the referral rate significantly (p=0.006) by about 70% (95%CI=(23%,87%)). In borough C, the three-month service disruption, also significantly (p=0.005), reduced the referral rate by about 49% (95% CI=(18%,68%)). Conclusions Disrupting the IRIS service substantially reduced the rate of referrals to DVA service providers. Our findings are evidence in favour of continuous funding and staffing of IRIS as a system level programme.

scholarly journals Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation

2020 ◽  
Author(s):  
Jasmina Panovska-Griffiths ◽  
Alex Hardip Sohal ◽  
Peter Martin ◽  
Estela Barbosa Capelas ◽  
Medina Johnson ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Time Series ◽  
Service Providers ◽  
Interrupted Time Series ◽  
Referral Rate ◽  
System Level ◽  
Health Concern ◽  
Service Disruption ◽  
The Impact ◽  
Domestic Violence And Abuse

Abstract Background Domestic violence and abuse (DVA) is experienced by about 1/3 of women globally and remains a major health concern worldwide. IRIS (Identification and Referral to Improve Safety of women affected by DVA) is a complex, system-level, training and support programme, designed to improve the primary healthcare response to DVA. Following a successful trial in England, since 2011 IRIS has been implemented in eleven London boroughs. In two boroughs the service was disrupted temporarily. This study evaluates the impact of that service disruption.Methods We used anonymised data on daily referrals received by DVA service providers from general practices in two IRIS implementation boroughs that had service disruption for a period of time (six and three months). In line with previous work we refer to these as boroughs B and C. The primary outcome was the number of daily referrals received by the DVA service provider across each borough over 48 months (March 2013-April 2017) in borough B and 42 months (October 2013-April 2017) in borough C. The data were analysed using interrupted-time series, non-linear regression with sensitivity analyses exploring different regression models. Incidence Rate Ratios (IRRs), 95% confidence intervals and p-values associated with the disruption were reported for each borough.Results A mixed-effects negative binomial regression was the best fit model to the data. In borough B, the disruption, lasted for about six months, reducing the referral rate significantly (p=0.006) by about 70% (95%CI=(23%,87%)). In borough C, the three-month service disruption, also significantly (p=0.005), reduced the referral rate by about 49% (95% CI=(18%,68%)). Conclusions Disrupting the IRIS service substantially reduced the rate of referrals to DVA service providers. Our findings are evidence in favour of continuous funding and staffing of IRIS as a system level programme.

scholarly journals Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation

2019 ◽  
Author(s):  
Jasmina Panovska-Griffiths ◽  
Alex Hardip Sohal ◽  
Peter Martin ◽  
Estela Barbosa Capelas ◽  
Medina Johnson ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Time Series ◽  
Linear Regression ◽  
Service Providers ◽  
Interrupted Time Series ◽  
Referral Rate ◽  
System Level ◽  
Implementation Period ◽  
Service Disruption ◽  
Domestic Violence And Abuse

Abstract Background Domestic violence and abuse (DVA) remains a major health concern affecting an estimated 15%-71% of women worldwide. IRIS ( Identification and Referral to Improve Safety of women affected by DVA) is a complex, system-level, training and support programme, designed to improve the primary healthcare response to DVA. Following a successful trial, since 2011 IRIS has been implemented in eleven London boroughs. In two boroughs the service was disrupted for a period of time and this work evaluates the impact of this service disruption. Methods We used anonymised data on daily referrals received by DVA service providers from general practices in two IRIS implementation boroughs that had service disruption for a period of time (six and three months). In line with previous work we refer to these as boroughs B and C. The primary outcome was the number of daily referrals received by the DVA service provider across each borough over 48 months (March 2013-April 2017) in borough B and 42 months (October 2013-April 2017) in borough C. The data were analysed using interrupted-time series, non-linear regression analysis with sensitivity studies exploring different regression models. Incidence Rate Ratios (IRRs) and 95% confidence intervals and p-values associated with the disruption were reported for each borough. Results Mixed-effects negative binomial regression was the best fit model to the data. In borough B, the disruption, that occurred towards the end of the implementation period and lasted for about 6 months, significantly (p=0.006) reduced the referral rate by about 70% (95%CI=(23%,87%)). In borough C, the three-month service disruption that occurred towards the middle of the implementation period, also significantly (p=0.005) reduced the referral rate by about 49% (95% CI=(18%,68%)). Conclusions Disrupting the IRIS service has substantially reduced the rate of referrals to DVA service providers. Our findings are evidence in favour of continuous funding of IRIS as a system level programme. Funding National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames. Keywords domestic violence and abuse, interrupted time-series, non-linear regression

scholarly journals Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation

2020 ◽  
Author(s):  
Jasmina Panovska-Griffiths ◽  
Alex Hardip Sohal ◽  
Peter Martin ◽  
Estela Barbosa Capelas ◽  
Medina Johnson ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Time Series ◽  
Linear Regression ◽  
Health Research ◽  
Service Providers ◽  
Interrupted Time Series ◽  
Referral Rate ◽  
System Level ◽  
Service Disruption ◽  
Domestic Violence And Abuse

Abstract Background Domestic violence and abuse (DVA) is experienced by about 1/3 of women globally and remains a major health concern worldwide. IRIS (Identification and Referral to Improve Safety of women affected by DVA) is a complex, system-level, training and support programme, designed to improve the primary healthcare response to DVA. Following a successful trial in England, since 2011 IRIS has been implemented in eleven London boroughs. In two boroughs the service was disrupted temporarily. This study evaluates the impact of that service disruption. Methods We used anonymised data on daily referrals received by DVA service providers from general practices in two IRIS implementation boroughs that had service disruption for a period of time (six and three months). In line with previous work we refer to these as boroughs B and C. The primary outcome was the number of daily referrals received by the DVA service provider across each borough over 48 months (March 2013-April 2017) in borough B and 42 months (October 2013-April 2017) in borough C. The data were analysed using interrupted-time series, non-linear regression with sensitivity analyses exploring different regression models. Incidence Rate Ratios (IRRs), 95% confidence intervals and p-values associated with the disruption were reported for each borough. Results A mixed-effects negative binomial regression was the best fit model to the data. In borough B, the disruption, lasted for about six months, reducing the referral rate significantly (p=0.006) by about 70% (95%CI=(23%,87%)). In borough C, the three-month service disruption, also significantly (p=0.005), reduced the referral rate by about 49% (95% CI=(18%,68%)). Conclusions Disrupting the IRIS service substantially reduced the rate of referrals to DVA service providers. Our findings are evidence in favour of continuous funding and staffing of IRIS as a system level programme. Funding National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames. Keywords domestic violence and abuse, interrupted time-series, non-linear regression

scholarly journals Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation

2020 ◽  
Author(s):  
Jasmina Panovska-Griffiths ◽  
Alex Hardip Sohal ◽  
Peter Martin ◽  
Estela Barbosa Capelas ◽  
Medina Johnson ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Time Series ◽  
Linear Regression ◽  
Health Research ◽  
Service Providers ◽  
Interrupted Time Series ◽  
Referral Rate ◽  
System Level ◽  
Service Disruption ◽  
Domestic Violence And Abuse

Abstract Background Domestic violence and abuse (DVA) is experienced by about 1/3 of women globally and remains a major health concern worldwide. IRIS (Identification and Referral to Improve Safety of women affected by DVA) is a complex, system-level, training and support programme, designed to improve the primary healthcare response to DVA. Following a successful trial in England, since 2011 IRIS has been implemented in eleven London boroughs. In two boroughs the service was disrupted temporarily. This study evaluates the impact of that service disruption. Methods We used anonymised data on daily referrals received by DVA service providers from general practices in two IRIS implementation boroughs that had service disruption for a period of time (six and three months). In line with previous work we refer to these as boroughs B and C. The primary outcome was the number of daily referrals received by the DVA service provider across each borough over 48 months (March 2013-April 2017) in borough B and 42 months (October 2013-April 2017) in borough C. The data were analysed using interrupted-time series, non-linear regression with sensitivity analyses exploring different regression models. Incidence Rate Ratios (IRRs), 95% confidence intervals and p-values associated with the disruption were reported for each borough. Results A mixed-effects negative binomial regression was the best fit model to the data. In borough B, the disruption, lasted for about six months, reducing the referral rate significantly (p=0.006) by about 70% (95%CI=(23%,87%)). In borough C, the three-month service disruption, also significantly (p=0.005), reduced the referral rate by about 49% (95% CI=(18%,68%)). Conclusions Disrupting the IRIS service substantially reduced the rate of referrals to DVA service providers. Our findings are evidence in favour of continuous funding and staffing of IRIS as a system level programme. Funding National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames. Keywords domestic violence and abuse, interrupted time-series, non-linear regression

scholarly journals Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jasmina Panovska-Griffiths ◽  
Alex Hardip Sohal ◽  
Peter Martin ◽  
Estela Barbosa Capelas ◽  
Medina Johnson ◽  
...  
Keyword(s):  
Health Care ◽  
Domestic Violence ◽  
Time Series ◽  
Primary Health Care ◽  
Interrupted Time Series ◽  
Primary Health ◽  
Series Evaluation ◽  
Domestic Violence And Abuse

scholarly journals 47. Impact of COVID-19 Pandemic on an Emergency Department Opt-out HIV Screening Program: An Interrupted Time Series Analysis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S33-S34
Author(s):  
Jianli Niu ◽  
Paula Eckardt
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Hiv Testing ◽  
Interrupted Time Series ◽  
South Florida ◽  
Health Concern ◽  
Public Healthcare ◽  
Opt Out ◽  
Hiv Test ◽  
The Impact

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has posed tremendous challenges to health care systems, including emergency department (ED) priorities and visits. We describe the impact of COVID-19 pandemic on ED-based “Opt-out” HIV testing at a public healthcare system in South Florida. Methods The programmatic data of ED-based HIV testing from July 2018 to March 2021 at the Memorial Regional Hospital, Hollywood, Florida was retrospectively analyzed. Interrupted time series (ITS) analysis models were developed to evaluate the immediate and gradual effects of the pandemic on the monthly number of HIV tests over time, with an interruption point at March 2020. Results 45,185 HIV tests were recorded between July 2018 and March 2021. A mean of 1,745 (SD, 266) HIV tests per month before the COVID-19 pandemic (July 2018 to Feb 2020) and a mean of 791 (SD, 187) HIV tests per month during the pandemic period (March 2020 to March 2021) was seen (p< 0.0001). As shown in Table 1, there was a slight decline trend in the number of monthly HIV test before the pandemic (estimate -10.29, p=0.541). We estimated a significant decrease in monthly HIV tests (estimate -678.48, p = 0.008), whereas the slope change after the pandemic was non-significant (estimate 4.84, p = 0.891). The number of monthly HIV tests declined significantly during the early phase of the pandemic, particularly between March 2020 and September 2020 (all p< 0.05), with an estimated 48.0% decrease in the March 2020 (estimate -678.48, p = 0.007), 43% in the April 2020 (estimate -673.65, p=0.007), and 50.7% in the May 2020 (estimate -668.83, p=0.009), compared with the same month of the pre-pandemic period (Figure 1). This decline in number of monthly HIV tests is consistent with the first wave of the COVID-19 pandemic in South Florida. Number of decreased monthly HIV tests from October 2020 through March 2021 was less pronounced (all p >0.05) and returned to pre-pandemic levels. Conclusion The COVID-19 pandemic led to a significant and immediate decline in monthly number of ED-based HIV tests. Disruption of basic health services by the COVID-19 pandemic is a public health concern. Strategies to develop an infrastructure to meet the demands of HIV testing should be implemented to ensure the current HIV prevention during the COVID-19 period. Disclosures All Authors: No reported disclosures

scholarly journals Impact of the first national COVID-19 lockdown on referral of women experiencing domestic violence and abuse in England and Wales

2021 ◽  
Author(s):  
Jasmina Panovska-Griffiths ◽  
Eszter Szilassy ◽  
Medina Johnson ◽  
Sharon Dixon ◽  
Anna Simoni ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Incidence Rate Ratio ◽  
Interrupted Time Series ◽  
Access To Services ◽  
Future Planning ◽  
England And Wales ◽  
Before And After ◽  
General Practices ◽  
The Impact ◽  
Domestic Violence And Abuse

Abstract Background The COVID-19 pandemic, with the related lockdown periods to curb transmission, has made it harder for survivors of domestic violence and abuse (DVA) to disclose abuse and access support services. Our study describes the impact of the first COVID-19 wave and the associated national lockdown in England and Wales on the referrals from general practice to the IRIS (Identification and Referral to Improve Safety) DVA programme. We compare this to the change in referrals in the same months in the previous year, during the school holidays in the three years preceding the pandemic and the period just after the first COVID-19 wave. School holiday periods were chosen as a comparator, since families, including the perpetrator, are together, affecting access to services. Methods We used anonymised data on daily referrals received by the IRIS DVA service in 33 areas from general practices over the period April 2017-September 2020. Interrupted-time series and non-linear regression were used to quantify the impact of the first national lockdown in March-June 2020 comparing analogous months the year before, and the impact of school holidays (01/04/2017-30/09/2020) on number of referrals, reporting Incidence Rate Ratio (IRR), 95% confidence intervals and p-values. Results The first national lockdown in 2020 lead to reduced number of referrals to DVA services (27%,95%CI=(21%,34%)) compared to the period before and after, and 19% fewer referrals compared to the same period in the year before. A reduction in the number of referrals was also evident during the school holidays with the highest reduction in referrals during the winter 2019 pre-pandemic school holiday (44%,95%CI=(32%,54%)) followed by the effect from the summer of 2020 school holidays (20%,95%CI=(10%,30%)). There was also a smaller reduction (13%-15%) in referrals during the longer summer holidays 2017–2019; and some reduction (5%-16%) during the shorter spring holidays 2017–2019. Conclusions We show that the COVID-19 lockdown in 2020 led to decline in referrals to DVA services. Our findings suggest an association between decline in referrals to DVA services for woman experiencing DVA and prolonged periods of systemic closure proxied here by both the first COVID-19 national lockdown or school holidays. This highlights the need for future planning to provide adequate access and support for people experiencing DVA during future national lockdowns and during the school holidays.

scholarly journals PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic (PRECODE): protocol of a rapid mixed-methods study in the UK

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Eszter Szilassy ◽  
Estela Capelas Barbosa ◽  
Sharon Dixon ◽  
Gene Feder ◽  
Chris Griffiths ◽  
...  
Keyword(s):  
Primary Care ◽  
Domestic Violence ◽  
Time Series ◽  
Linear Regression Analysis ◽  
Sensitivity Analyses ◽  
Series Data ◽  
The Uk ◽  
The Impact ◽  
Domestic Violence And Abuse ◽  
Care Response

Abstract Background The implementation of lockdowns in the UK during the COVID-19 pandemic resulted in a system switch to remote primary care consulting at the same time as the incidence of domestic violence and abuse (DVA) increased. Lockdown-specific barriers to disclosure of DVA reduced the opportunity for DVA detection and referral. The PRECODE (PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic) study will comprise quantitative analysis of the impact of the pandemic on referrals from IRIS (Identification and Referral to Improve Safety) trained general practices to DVA agencies in the UK and qualitative analysis of the experiences of clinicians responding to patients affected by DVA and adaptations they have made transitioning to remote DVA training and patient support. Methods/Design Using a rapid mixed method design, PRECODE will explore and explain the dynamics of DVA referrals and support before and during the pandemic on a national scale using qualitative data and over four years of referrals time series data. We will undertake interrupted-time series and non-linear regression analysis, including sensitivity analyses, on time series of referrals to DVA services from routinely collected data to evaluate the impact of the pandemic and associated lockdowns on referrals to the IRIS Programme, and analyse key determinants associated with changes in referrals. We will also conduct an interview- and observation-based qualitative study to understand the variation, relevance and feasibility of primary care responses to DVA before and during the pandemic and its aftermath. The triangulation of quantitative and qualitative findings using rapid analysis and synthesis will enable the articulation of multiscale trends in primary care responses to DVA and complex mechanisms by which these responses have changed during the pandemic. Discussion Our findings will inform the implementation of remote primary care and DVA service responses as services re-configure. Understanding the adaptation of clinical and service responses to DVA during the pandemic is crucial for the development of evidence-based, effective remote support and referral beyond the pandemic. Trial registration PRECODE is an observational epidemiologic study, not an intervention evaluation or trial. We will not be reporting results of an intervention on human participants.

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