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Interventions to prevent aggression against doctors: a systematic review
  1. Ann Raveel1,
  2. Birgitte Schoenmakers1,2
  1. 1 Public Health and Primary Care, KU Leuven, Leuven, Belgium
  2. 2 Public Health and Primary Care, University Leuven, Leuven, Belgium
  1. Correspondence to Birgitte Schoenmakers; birgitte.schoenmakers{at}


Objective To find out if there is evidence on interventions to prevent aggression against doctors.

Design This systematic review searched the literature and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources Pubmed, Embase, Turning Research into Practice (TRIP), Cochrane and Psycharticle, GoogleScholar and were consulted.

Eligibility criteria Abstracts published in English between January 2000 and January 2018 were screened. Eligible studies focused on prevention and risk factors of type II workplace violence in general healthcare, psychiatric departments, emergency departments, emergency primary care, general practice.

Data extraction and synthesis The selected intervention studies were grouped into quantitative and qualitative studies. Systematic reviews were reported separately. For each study, the design, type of intervention and key findings were analysed. Quality rating was based on Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (CERQUAL).

Results 44 studies are included. One randomised controlled trial (RCT) provided moderate evidence that a violence prevention programme was effective in decreasing risks of violence. Major risk factors are long waiting times, discrepancy between patients’ expectations and services, substance abuse by the patient and psychiatric conditions. Appropriate workplace design and policies aim to reduce risk factors but there is no hard evidence on the effectiveness. One RCT provided evidence that a patient risk assessment combined with tailored actions decreased severe aggression events in psychiatric wards. Applying de-escalation techniques during an aggressive event is highly recommended. Postincident reporting followed by root cause analysis of the incident provides the basic input for review and optimisation of violence prevention programmes.

Conclusions This review documented interventions to prevent and de-escalate aggression against doctors. Aggression against physicians is a serious occupational hazard. There is moderate evidence that an integrated violence prevention programme decreases the risks of patient-to-worker violence. The review failed to gather sufficient numerical data to perform a meta-analysis. A large-scale cohort study would add to a better understanding of the effectiveness of interventions.

  • aggression
  • general practitioner
  • workplace violence
  • interventions

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  • Contributors AR: setting up the design and method, data acquisition and analysis, interpretation of data, drafting the paper, approving the final version, accountable for the entire work. BS: delivering the research question, supporting, reviewing and revising the research process, performing data quality check, revising the manuscript for publication, accountable for both the work and the researcher.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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