This project outlines the need for firearm safe storage counseling in the medical encounter and provides some evidence-based suggestions regarding how to approach conversations about safe firearm storage with patients.https://scholarworks.uvm.edu/fmclerk/1704/thumbnail.jp

Martin, Rose

English

ScholarWorks @ UVM

University of Vermont ScholarWorks @ UVM Family Medicine Clerkship Student Projects Larner College of Medicine 2020 Conversations about safe firearm storage with patients: why and how Rose Martin University of Vermont Larner College of Medicine Follow this and additional works at: https://scholarworks.uvm.edu/fmclerk  Part of the Medical Education Commons, Primary Care Commons, and the Public Health Commons Recommended Citation Martin, Rose, "Conversations about safe firearm storage with patients: why and how" (2020). Family Medicine Clerkship Student Projects. 615. https://scholarworks.uvm.edu/fmclerk/615 This Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion in Family Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contact donna.omalley@uvm.edu. Slide 1: Tips for providers on firearm safe storage conversations with patientsR O S E  M A R T I NF A M I L Y  M E D I C I N E  C L E R K S H I P  R O T A T I O N  4C O L C H E S T E R  F A M I L Y  P R A C T I C E2 0 2 0#2 Problem IdentificationEstimated 50.5% of Vermonters own at least one firearmNational Shooting Sports Foundation CEO says that “record-breaking” firearm purchases during COVID have been largely made by first-time gun owners, who may not be familiar with safe storage practicesOn average, 64 Vermonters die by firearm suicide annually ➢In addition, 86% of all gun deaths in Vermont are suicidesSafe firearm storage has been shown to make a difference in the number of gun-related injuries:➢There is a lower risk of self-inflicted firearm injuries and deaths in homes in which guns are stored securely ➢Accidental firearm deaths in the United States decreased by 38% in the decade following the initiation of ChildSafe’s national campaign (2005-2015, per CDC) for gun safety in the home➢A 2019 study of a nationally representative sample of suicide decedents found that individuals living in households with safe storage practices were less likely to commit suicide using a firearm#3 Unique Cost Considerations Johns Hopkins’ 2017 study of over 700,000 people who required treatment for a firearm-related injury demonstrated that firearm-related injuries account for over 2.8 billion dollars in emergency and inpatient care annually.➢Of note, more than 50% of patients in this national study were uninsured or self-paying– meaning the individuals either bear the burden of the charge, or the bill added to the overall uncompensated care provided by health care systems➢Moreover, this study failed to account for pre-hospital deaths or injuries for which the individual did not seek medical care. Thus, the cost of gun violence in this study is likely a low estimate.#4 Community Perspective and Response to IssueTwo interviews recorded: one with a St. Albans native and former gun owner, and the other with a UVM Larner College of Medicine medical student.The medical student noted that there “have not been any school-specific lessons that discuss firearm safety.” She responded that it would be “helpful to see more examples of doctors counseling on the topic.”When asked if she thinks a clinical skills session on general safety (counseling re: smoke detectors, helmets, seatbelts/car seats, firearm storage) would be helpful, she says, “definitely” and notes that firearm safety could be incorporated into the social history we learn in the first year of medical school.The Vermonter I spoke with owned more than 5 firearms for collecting and target shooting. He notes that he has never been asked by a healthcare provider about firearms. When asked if he would be open to a healthcare provider asking him how he stored his firearms, he says, “yes, it makes sense why they would ask.”He notes that he was not aware that many Vermont police departments offer free firearm locks for community members.#5 Intervention and MethodologyPresentation for providers and staff at Colchester Family Practice that focused on safe storage practices and non-judgmental ways to approach gun safety within the patient encounter– along with a discussion of local resources for firearm safety.#5 ContinuedAvailable pamphlet that lists options for firearm storage with helpful categories on the right-hand side that highlight features of each option (e.g., “affordable,” “portable,” “theft deterrent”)#6 Results/ResponseAfter the presentation, the providers and I discussed the renewed importance of this topic in the wake of COVID-19 and increased civil discord in the midst of the recent election. We considered the persistent barriers to having discussions around firearms in settings where patients may feel uncomfortable or defensive about the topic. Overall, feedback on the presentation was that it is helpful to have reminders of how to best approach oftentimes-sensitive topics like these.#7 Effectiveness and Limitations➢ To measure effectiveness, a quick 10-question assessment could be administered to gauge providers’ knowledge levels about safe firearm storage.➢ Alternatively, providers could be asked to participate in a survey to assess their comfort levels counseling on gun safe storage before and then after the presentation. ➢ As discussed previously, the effectiveness of counseling on firearm safe storage is limited by patient openness to the discussion, as well as provider time limitations.#8 Recommendations for future Interventions➢ Potential to incorporate lessons on gun safety counseling into medical school curriculum➢Would be helpful to assess specific barriers and concerns when broaching the topic of gun safety to be able to more directly address provider hesitations#9 ReferencesAli Rowhani-Rahbar, Joseph A. Simonetti, Frederick P. Rivara, Effectiveness of Interventions to Promote Safe Firearm Storage, Epidemiologic Reviews, Volume 38, Issue 1, 1 January 2016, Pages 111–124, https://doi.org/10.1093/epirev/mxv006Betz ME , Flaten HK , and Miller M . Older adult openness to physician questioning about firearms [Letter]. J Am Geriatr Soc. 2015;63:2214-5. [PMID: 26480997] doi:10.1111/jgs.13695Carbone PS, Clemens CJ, Ball TM. Article. Arch Pediatr Adolesc Med. 2005;159(11):1049–1054. doi:10.1001/archpedi.159.11.1049CBS News staff. "Gun Ownership and Gun Violence in America, by the Numbers." CBSNews.com, 15 February 2018.Everytown for Gun Safety. Unload, Lock, and Separate: Secure Storage Practices to Reduce Gun Violence. (2020, August 02). Retrieved November 21, 2020, from https://everytownresearch.org/report/unload-lock-and-separate-secure-storage-practices-to-reduce-gun-violence/Gani, F., Sakran JV., & Canner, JK. (2017) Emergency Department Visits For Firearm-Related Injuries In The United States, 2006–14. Health Affairs 36:10, 1729-1738Mann JJ, Michel CA. Prevention of Firearm Suicide in the United States: What Works and What Is Possible. Am J Psychiatry. 2016 Oct 1;173(10):969-979. doi: 10.1176/appi.ajp.2016.16010069. Epub 2016 Jul 22. PMID: 27444796.Pallin, R., Spitzer, S. A., Ranney, M. L., Betz, M. E., & Wintemute, G. J. (2019). Preventing Firearm-Related Death and Injury. Annals of Internal Medicine, 170(11). doi:10.7326/aitc201906040Project Child Safe. “Gun Storage for your Lifestyle.” https://projectchildsafe.org/wp-content/uploads/2020/05/PCS_SafeStorage_19.pdfSege RD , Hatmaker-Flanigan E , DeVos E , Levin-Goodman R , and Spivak H . Anticipatory guidance and violence prevention: results from family and pediatrician focus groups. Pediatrics. 2006;117:455-63. [PMID: 16452366]Walters H , Kulkarni M , Forman J , Roeder K , Travis J , and Valenstein M . Feasibility and acceptability of interventions to delay gun access in VA mental health settings. Gen Hosp Psychiatry. 2012;34:692-8. [PMID: 22959420] doi:10.1016/j.genhosppsych.2012.07.012Wintemute, G. J., Betz, M. E., & Ranney, M. L. (2016). Yes, You Can: Physicians, Patients, and Firearms. Annals of Internal Medicine, 165(3), 205. doi:10.7326/m15-2905

Conversations about safe firearm storage with patients: why and how

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Conversations about safe firearm storage with patients: why and how

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