Barriers to care and intimate partner violence screen in orthopaedic trauma clinic.

Abstract

To evaluate the prevalence of barriers to care and IPV risk and assessed associations between economic hardship and violence. A prospective, cross-sectional survey was performed recruiting adult orthopedic trauma patients presenting for clinical follow up at one Level 1 orthopaedic trauma center. Primary outcomes were SDoH domains and IPV risk. Associations between patient characteristics, barriers to care, and IPV risk were analyzed using Fisher's exact tests with false discovery rate control. Among 261 respondents, 50.6% reported difficulty paying for basic needs, while 26.2% reported food insecurity and 25.2% transportation barriers. Positive IPV screens were driven largely by emotional abuse (17.7%), compared with physical hurt (3.3%). Financial hardship was the strongest predictor of barriers to care (OR 48.8, p < 0.001) and was associated with overall IPV risk (OR 3.31, p < 0.001), increasing the odds of threats of harm by over 28-fold. Tobacco use (OR 3.35, p < 0.001) and monthly alcohol use (OR 3.26, p = 0.01) were also associated with IPV risk. Nearly one-third of patients (28.8%) requested connection to supportive resources. Orthopaedic trauma patients experience a substantial burden of unmet social needs and IPV risk. Financial hardship and substance use are associated with barriers to care and IPV exposure, and many patients desired connection to resources. Trauma clinics represent a critical point for identification, but screening alone is insufficient without embedded referral pathways to provide timely support. Level II; survey study.