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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