Guidance
10 The evidence
The evidence statements from 1 review are provided by an external contractor (see Evidence). This section lists how the evidence statements and expert reports link to the relevant recommendations and sets out a brief summary of findings from the economic analysis and the fieldwork.
The evidence statements are short summaries of evidence, in a review, report or paper (provided by an expert in the topic area). Each statement has a short code indicating which document the evidence has come from. The letters in the code refer to the type of document the statement is from, and the numbers refer to the document number, and the number of the evidence statement in the document.
Evidence statement number 1 indicates that the linked statement is numbered 1 in the review 'Review of interventions to identify, prevent, reduce and respond to domestic violence and abuse'. Evidence statement ER1 indicates that the evidence is in the expert report 1 'Current health and social care interventions on domestic violence and abuse'.
The review, expert reports and economic analysis are available online. Where a recommendation is not directly taken from the evidence statements, but is inferred from the evidence, this is indicated by IDE (inference derived from the evidence).
-
Recommendation 1: ER1
-
Recommendation 2: evidence statement 30–33
-
Recommendation 3: evidence statements 30–33
-
Recommendation 4: evidence statements 9, 30–-33
-
Recommendation 5: evidence statements 3, 8, 9; ER2–5
-
Recommendation 6: evidence statements 11–14
-
Recommendation 7: evidence statements 3, 33
-
Recommendation 8: evidence statements 8–10, 31
-
Recommendation 9: evidence statement 33; ER2–5
-
Recommendation 10: evidence statements 8, 9, 30–33
-
Recommendation 11: evidence statements 27–29
-
Recommendation 12: evidence statements 10–12, 27, 28
-
Recommendation 13: evidence statements 13, 14
-
Recommendation 14: evidence statements 15, 17; ER2
-
Recommendation 15: evidence statements 8–10, 30
-
Recommendation 16: evidence statements 8,9, 31–33
-
Recommendation 17: evidence statements 8, 9, 30
Review of economic evaluation
Two papers were included in the review. These reported findings from a pilot intervention to prevent domestic violence (Norman et al. 2010) and a cluster RCT of the intervention (Devine et al. 2012).This multi-faceted intervention included: education of doctors about domestic violence and abuse; improved cross-system collaboration; use of electronic prompts for doctors to ask about intimate partner violence; use of prompts to encourage doctors to refer people who have experienced domestic violence to domestic violence and abuse advocates and to psychologists.
Moderate evidence from the UK perspective suggested that the interventions were cost effective, with an incremental cost–effectiveness ratio of £2450 when an additional quality-adjusted life year was valued at £20,000.
Economic modelling
Two interventions were modelled: the use of independent domestic violence services and cognitive trauma therapy for battered women.
Overall, the independent domestic violence adviser service intervention was found to be cost saving (that is, it both saves resources and improves quality of life) compared with no intervention. The overall message is that the cost of domestic violence and abuse is so significant that even marginally effective interventions are cost effective.
Cognitive trauma therapy for battered women saved £15 million by reducing the harm from domestic violence, compared with no intervention.
The results are subject to uncertainty and assumptions made in both models.
The key assumptions were explored in a series of sensitivity analyses. These analyses demonstrated that the interventions are cost effective, even when the costs and effects of the interventions varied.
Full details can be found in the Economic analysis of interventions to reduce the incidence and harm of domestic violence and abuse.
Fieldwork findings
Fieldwork aimed to test the relevance, usefulness and feasibility of putting the recommendations into practice. The PDG considered the findings when developing the final recommendations. For details, go to Fieldwork and Field testing NICE guidance on domestic violence and abuse: how social care, health services and those they work with can identify, prevent, and reduce domestic violence.
Fieldwork participants who come into contact with people who experience, or perpetrate, domestic violence and abuse were fairly positive about the recommendations and their potential to help identify, prevent and reduce this violence and abuse.
Many welcomed the holistic (multi-agency and multi-sector) approach and the comprehensive scope of the guidance (covering everything from strategy development to service delivery). The inclusion of a key role for public health – including NHS services – was especially welcomed, because participants felt that domestic violence and abuse has not been seen as a priority by the health sector in the past.
If the recommendations are implemented, participants felt that the overall standard of domestic violence and abuse service provision was likely to improve. (According to participants, current provision varies by locality, due to the uncertain and short-term nature of funding arrangements.)
However, recent changes in the commissioning of health and social care services were reported to have created confusion, with many participants saying that it is difficult to identify the relevant commissioners in their area. Some suggested that the guidance should more clearly identify accountable agencies and partnerships.