A recent study from the Oregon Health & Science University (OHSU) highlights a concerning trend in primary care: routine screenings for anxiety and intimate partner violence in women and adolescent girls are seldom conducted. This research indicates that despite national guidelines advocating for these essential screenings, implementation remains alarmingly low.
The study, which involved interviews with 27 clinicians and staff across 12 clinics in Oregon, was published in the Journal of the American Board of Family Medicine. Findings reveal that while healthcare providers express support for screening, many are unaware that these services are recommended and fully covered under the preventive services mandate of the Affordable Care Act.
Barriers to Effective Screening
According to the study’s senior author, Amy Cantor, M.D., M.P.H., a professor at OHSU, the research aimed to assess current practices in primary care settings. “We found widespread support, but limited uptake,” Cantor stated. Many clinicians confused anxiety screening with depression screening, despite the two being distinct recommendations that require different tools.
Official guidelines from the Women’s Preventive Services Initiative recommend screening for anxiety in women and girls, as well as for intimate partner and domestic violence. Alarmingly, fewer than half of the surveyed clinics reported conducting these screenings.
The study identified several barriers impacting screening rates, including “screening fatigue,” absence of clear referral pathways, and discomfort among providers when discussing intimate partner violence. Many clinics lacked standardized workflows and were uncertain about how to document and follow up on positive screenings.
Cantor noted, “Primary care clinicians are overwhelmed with what they’re expected to screen for.” She emphasized the importance of integrating anxiety and intimate partner violence screening into existing systems to make them a routine part of care.
Implementing Change with New Tools
Concerns about privacy and the ability to handle sensitive disclosures without adequate resources were also significant issues for providers when addressing intimate partner violence. Cantor advocates for normalizing these discussions by consistently asking all eligible patients in a supportive manner, which could help alleviate stigma. “Universal screening sends a message: This isn’t just about one type of patient,” she explained. “The consequences of missing intimate partner violence or untreated anxiety can be significant downstream.”
As part of the study’s outcomes, the research team developed step-by-step clinical workflow guides designed for screening, documentation, referrals, and billing resources. These tools are now available to clinicians, thanks in part to a collaboration with the OHSU Oregon Rural Practice-Based Research Network, which worked with clinics in rural and school settings across Oregon.
“These are tangible tools clinicians can use tomorrow,” Cantor remarked. “We hope they will simplify the process of identifying problems early and facilitating the care patients need.”
In addition to Cantor, co-authors from OHSU include Chrystal Barnes, M.P.H., Sonja Likumahuwa-Ackman, M.I.D., M.P.H., Tamar Wyte-Lake, D.P.T., M.P.H., Miranda Pappas, M.A., and Keeley Blackie, C.P.H., M.P.H., along with Heidi Nelson, M.D., M.P.H., from the Kaiser Permanente Bernard J. Tyson School of Medicine. The study received funding from a grant by the Health Resources and Services Administration through the Women’s Preventive Services Initiative.
The findings underscore a critical need for increased awareness and improved systems in primary care to ensure women and adolescent girls receive the screenings they need for anxiety and intimate partner violence.
