地域医療と健康教育

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Costs Effectiveness of Domestic Violence Screening in Primary Care Settings: A Comparison of 3 Methods

Ping-Hsin Chen, Sue Rovi, Ko-Yu Pan and Mark S Johnson

Purpose: To compare the cost effectiveness of brief domestic violence (DV) screening tools used in three screening protocols: self-administered, medical staff interview, and physician interview. Methods: We conducted secondary analyses of data collected at 4 urban primary care settings during July 2004 through June 2005. The primary study was a randomized trial of 523 female patients who were assigned to 1 of the 3 screening protocols. Inclusion criteria were women aged 18 or older and currently involved with a partner. Each screening protocol included two brief DV screening tools, HITS and WAST-Short. Patients completed a post-screening survey to assess time spent screening. Data on provider salaries and training costs were also collected. Outcome measures were the costs to have one DV disclosure for each screening protocol. Sensitivity analyses were conducted to assess the robustness of the cost analysis. Results: With an overall disclosure rate of 14%, no difference was found among the three protocols. Costs for one DV disclosure by screening protocol were $9.98 for the self-administered, $15.46 for the medical staff interview, and $62.03 for the physician interview. For each protocol, increases in disclosure rates, proportion of patients screened, or screening frequency might reduce the average costs of screening. Conclusions: Patient self-administered disclosure of DV is less costly compared with provider interview. In terms of costs, this study supports routine or universal DV screening in primary care settings.