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31-275 / Development, implementation and monitoring of Common protocol for a healthcare response to Gender Violence.
2005-2012

Spain
GOP Information  
 
Organisation sharing the GOP
Related practices from PaSQ database
Ministry of Health, Social Services and Equality

Topic

Clinical guidelines or pathways
There is no specified text here
Category
There is no specified text here
There is no specified text here
GOP Description
 
Implementation level
National
Regional
Clinical settings
Basically in Primary Care (PC), but they have also made progress in Specialized (hospitals)
Objectives
Its main target is to provide healthcare professionals with homogeneous action guidelines when faced with cases of violence specifically directed against women, covering both: care and follow-up as well as prevention and early detection.
Population
Healthcare professionals in primary and specialized care. Specially useful for PC professionals, as it is at this level that contact with victims of gender violence is more immediate and direct.

Healthcare managers:it provides a model of organization to plan and act on health care in cases of gender-based violence.
Methods
 
Methodology
ORGANIZATION: The National Health System Interterritorial Council agreed to create a Commission Against Gender Violence, presided by the Healthcare Secretary General and formed by the Public Health, Quality an Innovation Directorate General, representatives of each Autonomous Community, the Equality Policies General Secretariat, and the Women’s Institute, The Observatory on Women’s Health assuming its Secretary ship. This Commission held their first meeting in November, 2004.

In the Commission have established expert working groups to go planning different actions (adequacy of information systems, elaboration of epidemiological indicators, quality criteria for training, evaluation of performances, ethical and legal aspects)

PROCESS: The Protocol has been made after reviewed international scientific evidence and the protocols of action health in the Autonomous Communities (AC. regional governments). The document is the result of the discussion and consensus in the bosom of a working group composed of professionals of the AC and experts in health and gender-based violence. The document brings together general concepts and guidelines for healthcare action (signs and symptoms of suspicion, plans of action based on the status of women) and coordination with other sectors (justice, forces and bodies of security, social services, etc.).
Timeframe implementation
First 4 years(2005-2009):phase of dissemination/awareness-raising and training of professionals as well as the preparation of systems of health information (at least in PC). Awareness and training is continue.

The following 5 years:begin to measure impacts and outcomes in clinical practice (studies at the regional level)
Implementation tools available
-Common Protocol for the National Health System (NHS) and Protocols of the Autonomous Communities (AC) edited or revised with the release of the Common Protocol.

-The Commission Against Gender Violence (GV) of the NHS Interterritorial Council, coordinating all actions

-5 working groups of the Commission to go tracking implementation

-Annual Reports monitoring proceedings (indicators of epidemiological GV cases detected and registered in health services and training processes)
Implementation cost
2005-2009:reviews (scientific evidence of tools; analysis of legislation, policies, programs and initiatives, systematization and collection of indicators) (approx. 150,000€).
2009-2010. Grant Programs Annually to health services of regional Governments (total sum both years 7.250.000€)
2011-2012. Only budget dedicated to the civil servant employees involved
Results
 
Method used to measure the results
1. Epidemiological indicators (from medical history or part of injury)
See at:
http://www.msc.es/organizacion/sns/planCalidadSNS/pdf/equidad/A4ViolIndicadoresIng.pdf
2. Training for Professionals Indicators and Quality Criteria
See at: http://www.msc.es/organizacion/sns/planCalidadSNS/pdf/equidad/A4ViolCriteriosIng.pdf

3. Also, forms or templates to collect them, are available in the Annual Reports.
See at:
http://www.msssi.gob.es/organizacion/sns/planCalidadSNS/ivg2011Intro.htm Pages 108-146
Results
CASES DETECTED AND REGISTERED: In 2011, the NHS has detected and informed 9614 battered women of 14 years and older from the AC through grievous bodily harm as information source (91.6 per 100,000). 6083 women abused in those same ages have been cases communicated by the AC from the Medical History as source of information (70 per 100,000).
PROFESSIONALS TRAINING: In 2011, 13966 professionals who participated in 573 training activities that occupied a total of 5577 hours have formed. They were accredited within the formation, 79% (452). It highlights the increase of training in Emergency services.
Analysis of the results
PC almost quadruplicates term means the detection of cases made from SC. Physical abuse the most frequent. Speclevel detects increased frequency of sexual abuse. Current partner/ex-partner as alleged primary aggressor. Women battered by their partners or ex-partner high occur in young groups (20 to 39 years). In absolute number, women are mostly Spanish, but rates are higher in women of economic immigration. Difficulties to detect cases in pregnant women.
Students most come to training in professional women's health services although teaching teams highlight the predominance of medical men. Nursing has more concern for prevention and care of gender violence
Implementation barriers
 
Did you find implementation barriers?
Yes
Please describe implementation barriers
EPIDEMIOLOGICAL INDICATORS
Actual incidence difficult to assess without a study to correct duplication between sources and levels of care.
Lack of homogeneity in the codification of detected cases (PC/SC Information Systems)
It is necessary to train health professionals to register and obtain GV epidemiological indicators and in specific programs designed for collection. Assessment and monitoring of quality in care. Management of the user interface (PC/SC/Emergency)
TRAINING
Training on gender-based violence not included in pre-grades. Ministry should promote its inclusion. Training materials on-line are needed.
We only have absolute data from trained professionals, not of the scope of the training.
Describe the strategies used to overcome the barriers (If needed)
Training in prevention and early detection in gender violence in medicine and nursing internal resident (MIR and EIR in Spain) can be an opportunity, when they finish their gender violence training, they could develop clinical sessions in centres where they do their practices.

Working in collaboration with the autonomous communities and other General addresses of the Ministry (health information management professional) for obtaining common denominators for calculating rates of coverage (target population) of trained professionals
Other information
 
Other information about the GOP that you would like to add (Link or attached document)
All information:

-the source and design of the Common Protocol, review in 2012, to adapt it to the contexts of increasing vulnerability
-The follow-up reports, design of indicators, etc.
is available in Spanish and English on the website of the Ministry:
http://www.msssi.gob.es/organizacion/sns/planCalidadSNS/e02_t03_Comision.htm

-Research studies on screening tools and others can be located at:
http://www.msssi.gob.es/organizacion/sns/planCalidadSNS/e02_t03.htm
We attach the forms (data collection sheet) designed for the collection of Epidemiological indicators:
http://www.msc.es/organizacion/sns/planCalidadSNS/pdf/equidad/informeViolenciaGenero2009/genderViolence2009Report.pdf (pages 99-124)


31-275.zip
Contact information
 
Name: Yolanda Agra
Position/function: Senior Adviser
Department: General direction of Public Health, Quality and Innovation
Organisation: Ministry of Health, Social Services and Equality
City: Madrid
Country: Spain
Region: Madrid
E-mail: yagra@msssi.es
Phone: 34915964102
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