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A health perspective to the war in Israel and Palestine

Gene Feder, VISION Director and Professor of Primary Care at the University of Bristol, has written an opinion piece with colleagues commenting on events in Israel and Gaza from a public health and primary care perspective. Responding to the war in Israel and Palestine was published in December in the online edition of the British Journal of General Practice.

Gene and his colleagues are GPs working to further the development of family medicine in the occupied Palestinian territory, specifically in the West Bank, but with links to family medicine in Gaza through the United Nations Relief and Works Agency and through Medical Aid for Palestinians. They also have friends and family in Israel and Palestine.

They have three responses to the current crisis as informed by their work as GPs and connection to Palestinian primary care:

  1. A plea for the protection of health care and health professionals amid the war
  2. A plea for the preservation of public health amid war
  3. A recognition that in the aftermath of October 7th and the invasion of Gaza, the widespread direct and vicarious trauma in Israeli and Palestinian populations will result in permanent physical and emotional damage: the former in the shape of orthopaedic, neurological, and gynaecological (as a result of rape) harm, the latter in the form of widespread anxiety, depression, and post-traumatic stress disorder which will also cascade down the generations.

Given VISION’s commitment to developing evidence on violence prevention, we will be organising roundtable meetings bringing together researchers focusing on post-conflict violence reduction. This is an opportunity for dialogue, perhaps leading to new perspectives and research including systematic assessment of sustainable post-conflict interventions as well as further joint activities.

For further information on the opinion piece, please see: Responding to the war in Israel and Palestine

Photograph by Emad El Byed on Unsplash

Cost effectiveness of primary care training & support programme for secondary prevention of DVA

Recent research evaluated the cost-effectiveness of the Identification and Referral to Improve Safety plus (IRIS+) intervention compared with usual care using feasibility data derived from seven UK general practice sites.

IRIS+ is a training and support programme for clinicians working in primary care to aid in their identification of those experiencing or perpetrating domestic violence / abuse (DVA).

VISION Deputy Director, Dr Estela Capelas Barbosa and Director, Professor Gene Feder, worked with their University of Bristol colleagues to conduct a cost–utility analysis, a form of economic evaluation comparing cost with patient-centred outcome measures, as a means to measure the benefit obtained from the treatment or intervention.

The specific cost-utility analysis they conducted assessed the potential cost-effectiveness of IRIS+ which assists primary care staff in identifying, documenting and referring not only women, but also men and children who may have experienced DVA as victims, perpetrators or both.

The analysis showed that in practices that adopted the IRIS+ intervention, a savings of £92 per patient occurred. The incremental net monetary benefit was positive (£145) and the IRIS+ intervention was cost-effective in 55% of simulations (when the model is repeated with different assumptions).

The research team therefore concluded that the IRIS+ intervention could be cost-effective in the UK from a societal perspective though there are large uncertainties. To resolve these the team will conduct a large trial with further economic analysis.

For further information please see: Primary care system-level training and support programme for the secondary prevention of domestic violence and abuse: a cost-effectiveness feasibility model | BMJ Open

Or contact Dr Estela Capelas Barbosa at e.capelasbarbosa@bristol.ac.uk

Photo by Marcelo Leal on Unsplash

COVID-19 adaptations to a training and support programme to improve primary care response to domestic abuse

Dr Estela Capelas Barbosa, VISION Deputy Director has recently published, COVID-19 adaptations to a training and support programme to improve primary care response to domestic abuse: a mixed methods rapid study in the BMC Primary Care journal, with Lucy Downes, IRIS Network Director.

Increased incidence and/or reporting of domestic abuse (DA) occurred during the COVID-19 pandemic. As a result of the lockdowns across the UK, services providing support to victims had to adapt and consider adding methods of remote outreach to their programmes.

Identification and Referral to Improve Safety (IRIS) is a programme to improve the response to domestic abuse in general practice, providing training for general practice teams and support for patients affected by DA. The COVID-19 pandemic required those running the programme to adapt to online training and remote support.

Estela and Lucy employed a mixed methods rapid approach to this research in order to gather evidence around the relevance, desirability and acceptability of IRIS operating remotely. Quantitative IRIS referral data were triangulated with data from surveys and interviews. They found that the adaptation to online training and support of IRIS was acceptable and desirable.

This study contributes to practice by asserting the desirability and acceptability of training clinicians to be able to identify, ask about DA and refer to the IRIS programme during telephone/online consultations. The findings from this study may be of interest to (public) health commissioners when making commissioning decisions to improve the general practice response to domestic abuse.

For further information please see: COVID-19 adaptations to a training and support programme to improve primary care response to domestic abuse: a mixed methods rapid study | BMC Primary Care (springer.com)

Or contact Dr Estela Capelas Barbosa at e.capelasbarbosa@bristol.ac.uk

Photo by Chris Yang on Unsplash

Making change happen in primary care: the story of IRIS

VISION Director and Professor of Primary Care at the University of Bristol Medical School, Gene Feder, was a keynote speaker at the webinar: Making change happen in primary care – The IRIS story, on 28 November 2023.

With his co-presenter, Medina Johnson, CEO of IRIS, they shared the story of the concept and ambition that led to the beginning of the social enterprise established in 2017 to promote and improve the healthcare response to domestic violence and abuse (DVA).

DVA is a violation of human rights that damages the health of women and families. The health care sector, including primary care, has been slow to respond to the needs of patients affected by DVA, not least because of uncertainty about the effectiveness of training clinicians in identification and engagement with survivors of abuse.

To address that uncertainty, Gene and Medina conducted a cluster-randomised trial in Hackney and Bristol, finding that both identification and referral to specialist DVA services substantially increased in the intervention practices.

In the webinar they mapped the (not always smooth) trajectory from trial results to a nationally available programme commissioned by Integrated Care Boards (ICBs) and local authorities in over 50 areas to date, including getting into guidelines/policy, further implementation research, negotiating with commissioners, and setting up a social enterprise (IRISi) to drive the scaling up of the intervention.

For further information please watch the webinar video below.

For any questions or comments, please contact IRISi at info@irisi.org

Training GPs remotely during COVID-19: Lessons learned

There may have been a rise in domestic abuse during the COVID-19 pandemic. At the same time general practice adopted remote working, which extended to training and education being delivered online.

IRIS (Identification and Referral to Improve Safety) is an example of an evidence-based UK healthcare training support and referral programme, focusing on DVA, which transitioned to remote delivery during the pandemic.

To understand the adaptations and impact of remote DVA training in IRIS-trained general practices a group of researchers – including VISION members Estela Barbosa and Gene Feder – explored the perspectives of those delivering and receiving training. 

It was found that remote DVA training in UK general practice widened access to learners. However, it may have reduced learner engagement compared with face-to-face training. DVA training is integral to the partnership between general practice and specialist DVA services, and reduced engagement risks weakening this partnership.

The researchers recommend a hybrid DVA training model for general practice, including remote information delivery alongside a structured face-to-face element. This has broader relevance for other specialist services providing training and education in primary care.

For further information please see: Adapting domestic abuse training to remote delivery during the COVID-19 pandemic: perspectives from general practice and support services | British Journal of General Practice (bjgp.org)

Or contact Estela Barbosa Capelas at estela.barbosa@city.ac.uk

Remote GP contact limits domestic violence care

General Practice has a central role in identifying and supporting those affected by DVA. Pandemic associated changes in UK primary care included remote initial contacts with primary care and predominantly remote consulting.

This paper explores general practice’s adaptation to DVA care during the COVID-19 pandemic. We found that the disruption caused by pandemic restrictions revealed how team dynamics and interactions before, during and after clinical consultations contribute to identifying and supporting patients experiencing DVA. Remote assessment complicates access to and delivery of DVA care.

This has implications for all primary and secondary care settings, within the NHS and internationally, which are vital to consider in both practice and policy.

For further information please see: General practice wide adaptations to support patients affected by DVA during the COVID-19 pandemic: a rapid qualitative study | BMC Primary Care | Full Text (biomedcentral.com)

Photo by National Cancer Institute on Unsplash