Effects of occupational violence on Australian general practitioners' provision of home visits and after-hours care: a cross-sectional study.

RATIONALE, AIMS AND OBJECTIVES: Occupational violence is increasingly recognized as a problem in general practice, and has been suggested as adversely affecting general practitioners' (GPs) provision of services to patients. The aim of this study was to investigate the association of experiences of violence and perceptions of risk of violence with provision of after-hours GP care and home visits. METHOD: A questionnaire-based cross-sectional survey of GPs in three Australian Urban Divisions of General Practice was used. RESULTS: Five hundred and twenty-eight GPs completed the survey (response rate 49%). Of the GPs surveyed, 63.7% were subjected to some form of violence in the previous 12 months. Risk of violence influenced 10.2% of GPs' delivery of in-hours home visits and 22.0% of GPs' delivery of after-hours home visits. A further 4.7% of GPs reported not performing after-hours home visits at all during the previous 12 months because of safety concerns. On logistic regression, gender, location of practice and country of medical qualification were significantly associated with provision of in-hours and after-hours home visits. Experience of violence during the previous 12 months was not significantly associated with provision of home visits. CONCLUSIONS: This study's finding of GPs' self-reported restriction of practice and withdrawal from home visits and after-hours calls in response to risk of violence represents a significant primary health care issue. GPs' decision to provide after-hours calls and home visits is complex, and the finding of lack of significant association of experiences of violence with provision of home visits and after-hours calls is likely to be due to the cross-sectional nature of the study.

Experiences of occupational violence in Australian urban general practice: a cross-sectional study of GPs.

OBJECTIVE: To establish the prevalence and characteristics of occupational violence in Australian urban general practice, and examine practitioner correlates of violence. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional questionnaire survey mailed to all members (n = 1085) of three urban divisions of general practice in New South Wales in August and September 2004. The three divisions were chosen to provide a range of socioeconomic status (SES) demographics. MAIN OUTCOME MEASURES: Occupational violence towards general practitioners during the previous 12 months. RESULTS: 528 GPs returned questionnaires (49% response rate). Of these, 63.7% had experienced violence in the previous year. The most common forms of violence were "low level" violence - verbal abuse (42.1%), property damage/theft (28.6%) and threats (23.1%). A smaller proportion of GPs had experienced "high level" violence, such as sexual harassment (9.3%) and physical abuse (2.7%). On univariate analysis, violence was significantly more likely towards female GPs (P < 0.001), less experienced GPs (P = 0.003) and GPs working in a lower SES status area (P < 0.001), and among practice populations encompassing greater social disadvantage (P = 0.006), mental health problems (P < 0.001), and drug- and alcohol-related problems (P < 0.001). Experience of violence was greater for younger GPs (P = 0.005) and those providing after-hours care (P = 0.033 for after-hours home visits). On multivariate analysis, a significant association persisted between high level violence and lower SES area (odds ratio [OR], 2.86), being female (OR, 5.87), having practice populations with more drug-related problems (OR, 5.77), and providing home visits during business hours (OR, 4.76). More experienced GPs encountered less violence (OR, 0.77) for every additional 5 years of practice. CONCLUSION: Occupational violence is a considerable problem in Australian urban general practice. Formal education programs in preventing and managing violence would be appropriate for GPs and doctors-in-training.