Few women are routinely screened for anxiety and intimate partner violence (IPV) in primary care, despite national recommendations and strong evidence supporting these practices. Heidi D. Nelson, MD, MPH, FACP, MRCP, Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM) Professor of Health Systems Science, and colleagues researched why these screenings remain underused, and how health systems can improve implementation. The study was published in the February 2026 issue of The Journal of the American Board of Family Medicine.
“This project served as a pilot to improve implementation of national screening recommendations in health systems and clinical practices,” said Dr. Nelson. “Materials are freely available in English and Spanish-language versions and can be further customized to specific practice settings. We plan to update these resources when needed, including adding a new HEDIS quality measure on IPV screening currently under development, and expand to other underutilized screening recommendations as funding allows.”
National clinical practice recommendations call for periodic universal screening for women and adolescent girls aged 13 years and older. Recommendations are based on evidence of effectiveness developed by Dr. Nelson’s team and supported by the Health Resources and Services Administration (HRSA) for coverage by most insurance plans under the preventive services mandate of the Affordable Care Act (ACA). To address the anxiety and IPV screening gap, the researchers aimed to identify barriers and facilitators for screening and develop clinical tools that would support wider adoption of screening practices.
The research team conducted semi‑structured interviews with clinicians and staff across 12 primary care clinics in Oregon, spanning both urban and rural networks. They found wide variation, and sometimes confusion, about current screening practices. For anxiety screening, clinicians frequently conflated it with screening for depression and failed to use validated anxiety measures, such as the Generalized Anxiety Disorder (GAD) scales (GAD‑2 and GAD‑7). For IPV screening, practices varied even more widely. While most clinics did not screen, some embedded one or two IPV questions into broader social needs assessments, and others relied solely on informal verbal questioning that was inadequately documented in the electronic health record (EHR).
Study participants identified several barriers that limited screening, including screening fatigue among patients and staff, time constraints during busy visits, and the absence of clear workflows, templates, or alerts in the EHR. The lack of quality metrics or billing codes tied to screening deprioritized these services relative to others. For IPV specifically, clinicians expressed heightened concerns regarding documentation, especially regarding compromising patient safety. Clinicians also expressed concern about their clinic’s ability to provide safe and effective support for patients disclosing IPV.
Several facilitators were also identified across clinics. Participants noted that embedding screening tools into the EHR, ideally with automatic prompts or reminders, would reduce missed opportunities for screening. Leveraging existing workflows, such as bundling anxiety or IPV screening with other routine assessments, such as screening for depression, was seen as an efficient strategy. Staff emphasized the need for specialized training to help clinicians approach IPV conversations in a trauma‑informed and culturally sensitive manner. They also highlighted the importance of consistent referral pathways, warm handoffs to behavioral health staff, and accessible community resources to support patients with positive screens.
Based on these findings, investigators consulted study participants to develop workflows to guide clinicians and clinical staff through the screening and referral process. Workflows were further supported by resource documents describing screening recommendations, validated screening tools, referral protocols, appropriate EHR documentation, billing and coding information, and educational resources. With these clinical support tools, primary care practices may improve their ability to identify and assist patients experiencing anxiety or IPV. Dr. Nelson presented the team’s findings at national meetings and clinical support resources are now available for clinicians.
Read the full study here .
