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背景大多数临床医生未接受过有关家庭暴虐的培训,未能对受虐待病人加以识别,即便事情败露,也难以确定管理。我们对初级保健培训和帮助项目的有效性进行检验,以增进对受家庭暴虐女性的识别,便于将她们转至专业咨询服务。方法本人群随机对照试验,我们选择英国哈克尼和布里斯托尔两都市初级保健信托机构全科诊所。聘用有本试验调查者诊所或排除那些未用电子记录诊所。通过女性医生比例、毕业后培训情况、病人注册数目和低收入人群百分比对诊所进行层化。在每个初级保健委托区域内,我们采用随机成分计算机-最小化方法将诊所随机分组:干预组或对照组。干预项目包括诊所培训课程、鼓励在医疗记录涵括虐待询问及向有从事家庭暴力咨询资质,并能提供培训和进一步咨询的转诊途径。主要结果为转至家庭暴力咨询服务的病人记录。前特异性次级结果为全科诊所电子医疗记录中的家庭暴虐识别记录。所有接受干预的诊所,做了Poisson回归聚类分析。诊所员工和研究伙伴知情,病人对参与研究不知情。发现我们将哈克尼和布里斯托尔符合入选条件———84家随机挑选51家(61%)全科诊所,其中24家接受,24家不接受培训和帮助项目,3家在试验开始前脱离。二次培训课程1年后,24家干预诊所记录有223例病人、24家对照诊所记录有12例病人转至专业咨询师{校正干预比率22.1[95%CI(11.5,42.4)]}。干预诊所记录有641例,对照诊所记录有236例存有家庭暴虐{校正干预率3.1[95%CI(2.2,4.3)]}。解释初级保健医生和行政管理者靶向培训和帮助项目改善了受家庭暴虐女性记录及向专业家庭暴虐机构转诊。我们的发现减少了初级保健家庭暴虐培训和帮助干预获益的不确定性,也表明女性病人家庭暴虐筛查不为提高识别及转至咨询师服务的必然情况。
Background Most clinicians have not received any training on family abuse and have not been able to identify abused patients. Even if things get out of hand, it is difficult to determine the management. We test the effectiveness of primary care training and help programs to increase the identification of women who are victims of family violence and facilitate their transfer to specialized counseling services. Methods In our randomized, controlled trial, we chose the General Clinics of Hackney and Bristol Metropolitan Primary Care Trusts in the United Kingdom. Hiring clinicians with this test or excluding those who have not used the electronic record clinic. The clinic is stratified by the ratio of female doctors, post-graduate training, the number of patients enrolled and the percentage of low-income people. Within each primary care entrusted area, we randomized the clinics to intervention or control using a random component computer-minimization approach. Intervention programs include clinic training courses, encouraging medical records to include abuse referrals and referrals to domestic violence counselors, and providing referral and referral for training and further counseling. The main result is a record of patient transfers to Domestic Violence Counseling Services. The pre-specific sub-result is a record of family violence identification in the electronic medical records of the general practice clinic. All intervention clinics did Poisson regression clustering analysis. Clinic staff and research associates are informed that patients are unaware of participating in the study. We found Hackney and Bristol to qualify - 84 randomly selected 51 (61%) general practice clinics, of whom 24 received, 24 did not receive training and assistance, and 3 were pre-trial Detached. One year after the second training course, 223 patients were recorded in 24 interventional clinics and 12 patients were recorded in 24 control clinics. {Corrected intervention rate 22.1 [95% CI (11.5, 42.4)]}. Interventions recorded 641 clinics and 236 clinics reported family violence (corrected intervention rate 3.1 [95% CI (2.2, 4.3)]}. Explain that primary care physicians and administrators target training and help programs to improve the recording of family violence among women and referrals to professional domestic abuse agencies. Our findings have reduced the uncertainty of primary care family violence training and the benefits of interventions and also demonstrated that domestic violence screening of female patients is not necessary to improve the identification and transfer to counselors.