Despite longstanding national recommendations advocating for routine anxiety and intimate partner violence (IPV) screening among women and adolescent girls, a new investigative study from Oregon Health & Science University (OHSU) exposes a significant disconnect between guidelines and practice within primary care environments. Through a qualitative exploration involving interviews with 27 clinicians and staff across a dozen Oregon clinics, researchers uncovered profound barriers that impede the consistent application of these essential screenings. The study, soon to be disseminated via the Journal of the American Board of Family Medicine, reveals that ignorance of existing mandates paired with logistical and emotional barriers severely limit screening uptake, challenging health systems to rethink implementation strategies.
At the core of this investigation lies a critical awareness gap. Many primary care providers are reportedly uninformed about the recommended protocols for anxiety and IPV screenings, let alone the fact these services are comprehensively covered under the preventive services mandate of the Affordable Care Act. This finding is striking given the crucial role primary care plays as a frontline touchpoint in detecting and addressing these often underrecognized health concerns. Not only is there a paucity of knowledge regarding screening guidelines, but conflation between anxiety and depression screenings further muddles clinical efforts, reflecting a need for enhanced educational initiatives targeted at healthcare providers.
The Women’s Preventive Services Initiative (WPSI) formally advises routine anxiety screening for adolescent and adult women, alongside universal IPV screening protocols. However, the research team observed that fewer than half of the evaluated clinics implemented both recommendations simultaneously. This underscores a fragmented adoption of best practices that potentially leaves many vulnerable individuals undetected and untreated. The research illuminated a pattern where clinics may selectively implement certain screenings but neglect others, possibly influenced by varying perceptions of patient needs or available resources.
Operational challenges represent formidable obstacles as well. The study pinpoints “screening fatigue” among providers as a palpable contributor to low adherence rates. In settings where clinicians are inundated with numerous preventive care mandates, the addition of anxiety and IPV screenings can feel like an untenable burden. Additionally, the absence of standardized workflows or clinical documentation practices impairs systematic integration. Providers often express uncertainty regarding follow-up protocols for positive screens, revealing gaps not only in screening but in the continuum of care necessary for effective intervention.
Provider discomfort, especially regarding IPV discussions, surfaced as a salient psychological barrier. Many clinicians expressed unease in broaching such sensitive subjects without adequate training or assurance of downstream support systems. Concerns about patient privacy and the implications of disclosure exacerbate these challenges, particularly in smaller or rural practices where resource availability might be constrained. The apprehension surrounding potential secondary trauma or safety risks for patients highlights the need for comprehensive training and robust referral pathways to accompany screening efforts.
Nevertheless, the study’s lead author, Dr. Amy Cantor, a professor intricately involved in medical informatics, family medicine, and obstetrics and gynecology at OHSU, advocates for a normalization strategy. By integrating anxiety and IPV screening universally into routine care — in a manner that is consistent, supportive, and destigmatizing — clinicians can mitigate the taboo often associated with these issues. Universal screening, Cantor espouses, not only bolsters early detection but also conveys a clear message that these concerns transcend demographic boundaries and affect all patients.
The consequences of neglecting these screenings can be severe and far-reaching. Untreated anxiety is linked to a spectrum of adverse health outcomes including diminished quality of life, chronic disease exacerbation, and increased mortality risk. Similarly, failure to identify IPV denies victims timely access to critical interventions, compounding physical, psychological, and social harms. Thus, integrating these screenings into primary care workflows is not merely a procedural enhancement, but a vital public health priority.
To bridge the implementation gap, the research team developed detailed clinical workflow guides designed to support primary care teams in seamlessly incorporating anxiety and IPV screenings. These tools encompass screening methodologies, documentation protocols, referral mechanisms, and billing procedures, offering a comprehensive framework adaptable across varied clinical settings. Leveraging collaborative networks such as the OHSU Oregon Rural Practice-Based Research Network enabled these resources to be trialed effectively within rural and school-based clinics, environments often burdened by amplified access challenges.
Such pragmatic resources aim to alleviate both logistical and psychological barriers, empowering clinicians to execute screenings confidently and efficiently. This approach acknowledges the complex ecosystem in which preventive services operate, recognizing that provider education, system integration, and resource availability must converge to catalyze sustained change. The study’s translational focus underscores the imperative to move beyond guideline dissemination toward actionable implementation strategies that resonate within the realities of everyday clinical practice.
Collectively, the findings from this Oregon-based initiative represent a critical call to action for healthcare systems nationwide. Closing the gap between recommendation and execution necessitates intensified training efforts, workflow innovations, and cultural shifts toward embracing sensitive conversations within primary care. By equipping providers with unequivocal knowledge, concrete tools, and supportive structures, the healthcare community can more effectively identify anxiety disorders and IPV, ultimately enhancing early intervention and improving patient outcomes on a broad scale.
This research was made possible through funding from the Health Resources and Services Administration (HRSA), facilitated by the Women’s Preventive Services Initiative (WPSI). The investigative team reflects a multidisciplinary collaboration involving experts in public health, medical informatics, and clinical practice. Their collective endeavor reaffirms the complex interplay between health policy, clinical delivery, and patient-centered care necessary to address pressing yet often overlooked health risks confronting women and adolescent girls.
In conclusion, while national guidelines offer a clear blueprint for anxiety and IPV screenings, the translating of these directives into routine primary care remains fraught with challenges. OHSU’s latest study sheds essential light on the multifactorial barriers at play and introduces concrete solutions to enhance screening fidelity. As healthcare systems grapple with mounting preventive care demands, integrating mental health and violence screening standards through robust, evidence-based workflows stands as a critical step toward improving holistic patient health and safety across diverse populations.
Subject of Research: People
Article Title: Barriers and Facilitators to Screening for Anxiety and Intimate Partner Violence
News Publication Date: 18-Feb-2026
Web References: http://dx.doi.org/10.3122/jabfm.2025.250108R1
Keywords: Human social behavior, Domestic violence
