Juggling confidentiality and safety:A qualitative study of how general practice clinicians document domestic violence in families with children

摘要

BackgroundDomestic violence and abuse (DVA) and child safeguarding are interlinked problems, impacting on all family members. Documenting in electronic patient records (EPRs) is an important part of managing these families. However, current evidence and guidance treats DVA and child safeguarding separately. This does not reflect the complexity clinicians face when documenting both issues in one family.AimTo explore how and why general practice clinicians document DVA in families with children.Design and SettingA qualitative interview study using vignettes with GPs and practice nurses in England.MethodSemi-structured telephone interviews with 54 clinicians (42 GPs and 12 practice nurses) were conducted across six sites in England. We analysed data thematically using a coding frame incorporating concepts form the literature and emerging themes. ResultsThe majority of clinicians recognised DVA and its impact on child safeguarding, but struggled to work out the best way to document it. They described tensions between the different roles of the EPR: a legal document, providing continuity of care, information sharing to improve safety, and a patient owned record. This led to strategies to hide information, so that it was only available to other clinicians.ConclusionManaging DVA in families with children is complex and challenging for general practice clinicians. National integrated guidance is urgently needed regarding how clinicians should manage the competing roles of the EPR, whilst maintaining safety of the whole family, especially in the context of online EPRs and patient access.