Barriers to Child Maltreatment Evaluation, Diagnosis and Management Among Family Medicine Physicians in the U.S.
Creators: name: Eniola, Kehinde
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2016

description: Objectives: The number of child maltreatment cases in the United States remains high and yet primary care providers such as family medicine physicians lack confidence and training to evaluate, diagnose and manage maltreated children. This study is to provide recommendations to improve family medicine physicians' confidence in the evaluation, diagnosis, and management of child maltreatment (CM). Methods: Family medicine residents and physicians practicing in the United States (U.S.) were emailed a survey; responses were collected from August through September 2015. Responders were asked questions about their familiarity and competence level in the evaluation, diagnosis and management of child maltreatment. Other questions asked included their frequency of correctly diagnosing cases of CM, timeliness of diagnosis, barriers to diagnosis or early diagnosis, and a question about receiving adequate CM training. Results: Out of the 420 survey emailed to family medicine residents and practicing physicians in all regions in the U.S., 258 (61%) surveys were completed. The majority of responders stated their level of competence in evaluating, diagnosing and management of child maltreatment as "average" or "below average" with very few (8%) indicating competence level "above average." Very few family medicine physicians and residents diagnose child maltreatment "once a month" or "2-3 times per month", and out of all responders, 46% reported a "timely" diagnosis of child maltreatment while a total of 54% were either "late" with their diagnosis or "could not recall." "Inexperience" was cited by 58% of respondents as one major barrier to diagnosing child maltreated, followed by "lack of confidence and certainty" cited by 50% of responders, "lack of diagnosis protocol" cited by 43.3% of responders, and "lack of confidence in communicating with parent" cited by 38.3% of responders. Surprisingly, "inadequate training" was only identified as a barrier by 34.9% of the responding family medicine physicians. Also, 70% of all responders agreed or strongly agreed that child maltreatment evaluation and management should be completed by other sub-specialty or expert in the field of child maltreatment, in addition to family medicine. Conclusion: Improving family medicine training in the aspect of child maltreatment by introducing it to residency training curriculum will improve family medicine physicians' confidence and competence level in evaluating, diagnosing and managing of child maltreatment. The child maltreatment curriculum will involve resident completing CM interviewing and examination modules online as well as shadowing clinicians who are experts in the aspect of CM evaluation and management. Developing CM diagnosis protocol by the American Association of Family Physicians (AAFP) will go a long way in improving confidence in the diagnosis of CM as well; this ensures that all physicians follow the same diagnostic protocol.