Firearms are now the leading contributor to adolescent mortality. Studies done in primary pediatric settings demonstrate that counseling families and distributing safe storage devices increase safe storage of firearms. However, health care providers (HCPs) infrequently screen for and/or address firearm safety. The purpose of this study was to determine whether utilizing the EMR to inform HCPs of the presence of firearms in the home increased HCP recognition of the presence of firearms, as well as increasing the delivery of a firearm safe storage message to parents.
Youth scheduled for a routine physical, or a mental health visit, were prescreened for the presence of household firearms. If youth and/or parent indicated that a firearm was present, they were eligible to participate in the study. Youth were randomized to one of three groups: 1) Control (HCP not notified electronically of firearm presence) 2) Means Restriction Counseling (MRC) Only - HCPs notified via chart messaging that youth screened positive for firearms or 3) MRC + distribution of safe storage devices (MRC +SSD). A chart review was conducted to determine whether the HCP documented the presence of firearms, and whether counseling was delivered. Parent recollection of the visit was done one week after the visit. T-tests were used to analyze results. The study was approved by the Colorado Multiple Institutional IRB
1336 youth/parent dyads were screened; 139 (10.4%) reported presence of firearms, and 76 (54.5%) agreed to participate and were enrolled. Youth study population were 34% male, 63% white, 18% Black, 32% Latino. Insurance status: 45.4% Public, 54.5% Commercial. Thirty percent were assigned the control group, and 41% to MRC, and 29% to MRC + SSD. HCPs delivered means restriction counseling to 15% of families in the control group, compared to 52.2% in the combined intervention groups (p=.009). HCPs documented the existence of firearms in the home in 50% of the control group compared to 58.7% of the combined intervention groups (p= .38). At one-week follow-up, 33% of control parents, 62% of MRC parents and 40% of MRC + SSD recalled hearing a message about safe storage/means restriction counseling. However, 90% of parents in which their child received a mental health diagnosis reported hearing a safe storage discussion, regardless of group assignment. Removing youth with a mental health diagnosis from the analysis, 53% of parents in the intervention groups recalled a safe storage message compared to 0 in the control group (p=.005).
Screening youth and parents for firearm access and embedding those results in the electronic medical record for the health care provider to view at the outset of an appointment led to both the provider delivering means restriction counseling/firearm safe storage message, and the parent recalling that a safe storage message was received. Pre-screening families for firearm access and embedding the results in the EMR therefore greatly enhances the delivery of a firearm safe storage message by health care providers.
Sources of Support
National Institute of Justice 2013-MU-CX-0002
© 2018 Published by Elsevier Inc.