Australian Journal of General Practice最新文献

Background: Coercive control is a pattern of behaviour that occurs in relationships and families that is enabled by broader coercive control systems in the community. General practitioners, skilled at pattern recognition, can contribute to systems-wide identification of coercive control across the lifespan.

Objective: This article uses the Sense of Safety Theoretical Framework to name processes that build sense of safety in healthy relationships. It therefore enables recognition of patterns of coercive control that destroy safety.

Discussion: Identifying coercive control is a key early intervention strategy for addressing domestic and family violence. Patterns of repeated invasion, confusion and isolation cause threat and enable coercive control by destroying freedom, clarity and belonging. Raising awareness of these patterns helps general practitioners to identify previously hidden processes that cause harm to the physical, emotional and social health of our community.

Background: Everyday general practice can benefit from integrating understanding of and care for trauma into whole person care. This facilitates new understandings of how lived experience, relationships, culture and context affect complex physiology, disease formation and overall health.

Objective: This article explores a generalist understanding of how trauma interacts with health, including the biology of trauma and the clinical implications of trauma-informed care. It discusses the general practitioner's (GP's) role in integrating an understanding of and care for trauma into a universal precautions approach to everyday practice.

Discussion: Integrating an understanding of and care for trauma into everyday general practice supports GPs to provide both humane whole person care and high-quality biomedical care. It enables early intervention in disease formation, allows GPs to unravel complex presentations and provides a framework for safe, trustworthy, collaborative, empowering and culturally respectful care.

Background: Coercive control by intimate partners is a major public health issue, negatively impacting women's health. Healthcare practitioners have a crucial role in responding yet often lack confidence to provide support.

Objective: This study explored Australian women's preferences for supportive messaging from health practitioners when discussing coercive control.

Discussion: An open-ended question in an online survey asked women who had experienced coercive control: 'What words could your health practitioner say that you would find helpful and supportive?'. Responses (n = 682) were analysed using directed content analysis. Findings align with two global frameworks: LIVES (Listen-Inquire-Validate-Enhance safety-Support) and CARE (Choice and control-Action and advocacy-Recognition and understanding-Emotional connection). Specific script health messaging is provided for healthcare practitioners to use in conversations with victim-survivors of intimate partner violence, including to counter coercively controlling tactics by abusive partners. Findings re-inforce the need for health practitioners to provide a sensitive first-line response, with tailored messaging to counteract affects of coercive control. Training and system support are needed to build health practitioner capacity to identify and respond to coercive control in the context of intimate partner violence.

Background: Intimate partner violence (IPV) is a common health issue, and members of families affected by violence frequently present to primary care. There are, however, barriers to general practitioners (GPs) identifying survivors, their children and those who use IPV.

Objective: This article explores the challenges of identifying family members affected by IPV in primary care. It also provides GPs with practical strategies in identifying IPV so that they can support affected families within their clinics.

Discussion: Survivors of IPV and their children might present to primary care with psychological, physical and social health issues. People who use violence might be less noticeable in the primary care setting. It is recommended that all family members presenting with potential indicators of IPV be asked about IPV, if safe to do so. A trauma- and violence-informed approach is recommended with a non-judgemental attitude, addressing confidentiality, safety and sensitivity.

Background and objectives: At the frontline of the healthcare system, general practitioners (GPs) regularly see the health consequences of traumatic life experiences, yet their perspectives on what constitutes trauma-informed primary care are not well understood. This qualitative study sought to explore Australian GPs' perspectives on trauma‑informed care.

Method: Fifteen GPs with an interest in supporting patients with histories of trauma and abuse were interviewed. Data were analysed thematically.

Results: Four key themes were identified: (1) shifts in understanding; (2) it is the relationship that is important; (3) dynamics of power and control; and (4) beyond the GP.

Discussion: This study sheds light on how GPs understand and seek to practise trauma‑informed care, and the factors that support and hinder them in this work. Findings support the need for greater integration of trauma-informed principles across the healthcare system, including in funding structures and training programs, and for increased support for GPs' own wellbeing.