Pediatrician interest in violence prevention: Results from 1998 and 2003 AAP Periodic Surveys.

M Trowbridge ¹, L Olson ², K O'Connor ², R Sege ¹ and H Spivak ¹. ¹Pediatric and Adolescent Health Research Center, Floating Hospital for Children at Tufts-New England Medical Center, Boston, MA and ²Department of Practice and Research, American Academy of Pediatrics, Elk Grove Village, IL.

 

Background: A 1998 AAP Periodic Survey of Fellows(#38) identified community violence (CV) and domestic violence (DV) as major concerns for pediatricians. They reported feeling unprepared to manage these issues in a clinical environment. In preparation for the upcoming Violent Injury Prevention Project, the AAP re-assessed these items in a 2003 Periodic Survey(#55).

 

Objective: 1.Analyze trends in reported incidence of DV and CV by pediatricians. 2.Describe changes in physician attitudes surrounding management and prevention of childhood injuries due to CV and DV.

 

Design/Methods: National random sample, mailed Periodic Surveys of AAP members: a)1998 (response=62%,n=1010) and b)2003 (response=53%,n=851). Chi-square tests used to assess bivariate relationships.

 

Results: The proportion of pediatricians who reported treating physical or emotional injuries due to DV and CV increased between 1998 and 2003 (DV:47% vs 38%,p<,001;CV:65% vs 41%,p<.001). The sharpest increases in reported incidence occurred in rural areas for both DV and CV(DV:71% vs 44%;CV: 77% vs 36%). The proportion of pediatricians who felt screening for DV was necessary increased (72% vs 66%,p=.023). A large majority continued to believe that screening for CV was necessary (77% vs 71%, n.s.). Belief in efficacy of prevention counseling increased for DV and remained unchanged for CV(DV:66% vs 52%,p<.001;CV: 56% vs 50%, n.s.). Although there was some improvement, only a minority of physicians believed that adequate resources were in place for both DV and CV(DV:44% vs 35%,p<.001; CV:41% vs 27%,p<.001). Confidence in ability to manage injuries due to DV improved but remained unchanged for CV(DV:52% vs 44%,p=.002; CV:50% vs 46%, n.s.). Agreement that adequate professional training had been received in both subject areas increased but remained sub-optimal(DV:30% vs 21%,p<.001; CV:24% vs 17%,p<.001). When asked if they would use an anticipatory guidance program modeled on TIPP but focused on violence prevention, 85% indicated they would be likely to utilize the program.

 

Conclusions: Pediatricians continue to identify domestic and community violence as important problems that should be targets of prevention counseling. However, despite some increases in confidence regarding management of these types of injuries, pediatricians continue to ask for improved training and available community services. There is strong demand for an AAP program to address violent injury.