Primary Care response to DVA in the Covid-19 pandemic

Aim To understand the impact of UK-wide COVID-19 social isolation policies on domestic violence and abuse (DVA) in the context of the general practice response during the pandemic and its aftermath, Research questions 1. What is the impact of COVID-19 social isolation policies on referral to specialist DVA support for patients experiencing abuse? 2. In remote consultations, how have GPs managed asking about/identifying abuse, giving support and offering referral to patients experiencing DVA amd how have they adapted to online DVA training? Methods Question 1: Interrupted-time series (ITS) and non-linear regression analysis including sensitivity analyses, using practice level referral data across 30 areas. Incidence rate ratios (IRR) and 95% confidence intervals of changes in referral rate before, during and reversal of social isolation policies, quantifying the impact of these COVID-19 prevention policies on DVA referrals. The analysis will cover one year before and one year after the implementation of social isolation (23/03/2019 - 22/03/2021) and the sudden national shift - for at least part of the second period - to online GP consultations. Question 2: Observation and interview-based qualitative study in a purposive sample of practices by ethnic and SES of population, and referral rates. Sampling of 30 GPs within selected practices and 10 other professionals (practice managers, DVA advocate educators); observation of 10 online training sessions. Thematic analysis. Triangulation of ITS with qualitative findings, exploring variation in the referral rates between areas, rapidly reporting relevance, feasibility, and safety of GP responses to DVA during the COVID-19 pandemic and its aftermath.