A training programme that teaches primary care teams how to identify domestic violence and abuse victims has led to a 30-fold increase in referrals, according to a new analysis.

The findings from the landmark study demonstrates that IRIS (Identification and Referral to Improve Safety) training and support programme for primary care teams should be rolled out across practices, say the authors.
A study of 205 general practices in London, led by Queen Mary University of London, with the Centre for Academic Primary Care, Bristol Medical School, found that IRIS led to a substantial increase in referrals.

The programme, which involves training the whole team at practices, including nurses, practice managers, healthcare assistants and ancillary staff, includes adapting electronic medical records to prompt health workers to ask further questions about domestic violence and abuse, when someone presents with clinical conditions such as depression, anxiety or injury. It also includes a simple referral pathway to a named domestic violence and abuse advocate, ensuring direct access for women to specialist services.

The study, published in BMC Medicine, compared practices in four London boroughs that had implemented the IRIS programme, with general practices in a fifth borough that had only received a stand-alone education session. Researchers found that in 144 practices that received full IRIS training, the referrals for domestic violence and abuse rose 30-fold, compared with no increase in referrals in the 61 practices in a comparator borough. IRIS also led to a 27% increase in newly identified women affected by domestic violence and abuse in the implementation borough, but not in the comparator borough.

The findings back up a previous smaller randomised controlled trial in London and Bristol, which showed that IRIS had been effective in identifying and referring women facing domestic abuse. Co-author Professor Chris Griffiths from Queen Mary University of London, added: “Health commissioners can now commission this programme with the confidence that it works in practice. IRIS can help GPs respond to the increased needs of women during COVID-19. Our work shows that the Mayor of London’s recent investment in rolling out the IRIS DVA programme across a further seven London boroughs is an excellent use of resource. Boroughs and Violence Reduction Units across the UK should follow this lead.”

Describing it as a “landmark study”, co-author Professor Gene Feder of University of Bristol said: “Our findings strengthen the case for the implementation of IRIS across the whole NHS and further development of a global primary care based response to DVA.”