Which Types of Providers Have Firearm Discussions in a Pediatric Primary Care Clinic?

Erica K Sheline; Eric J Sigel; Maya E Bunik; Jan Leonard; Mairead Dillon; Maya Haasz

doi:10.1016/j.acap.2024.07.013

Which Types of Providers Have Firearm Discussions in a Pediatric Primary Care Clinic?

Acad Pediatr. 2024 Jul 25:S1876-2859(24)00283-3. doi: 10.1016/j.acap.2024.07.013. Online ahead of print.

Authors

Erica K Sheline¹, Eric J Sigel², Maya E Bunik³, Jan Leonard⁴, Mairead Dillon⁴, Maya Haasz⁵

Affiliations

¹ Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16(th) Ave B251, Aurora, CO, 80045, USA. Electronic address: sheline.es@gmail.com.
² Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16(th) Ave B251, Aurora, CO, 80045, USA; Children's Hospital Colorado, Adolescent Medicine Clinic, 860 N Potomac Cir, Aurora, Colorado, 80011 USA.
³ Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16(th) Ave B251, Aurora, CO, 80045, USA; Children's Hospital Colorado, Child Health Clinic, 860 N Potomac Cir, Aurora, Colorado, 80011 USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, 1890 N Revere Ct, Aurora, CO, 80045, USA.
⁴ Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16(th) Ave B251, Aurora, CO, 80045, USA.
⁵ University of Colorado School of Medicine, Department of Pediatrics, Section of Emergency Medicine, 13123 E 16(th) Ave B251, Aurora, CO, 80045, USA.

PMID: 39067784
DOI: 10.1016/j.acap.2024.07.013

Abstract

Objective: Safe firearm storage decreases self-inflicted and unintentional firearm injury in youth. Medical providers are well-positioned to discuss safe firearm storage with families. The primary objective of this study was to determine which providers are most likely to discuss firearms with their patients. Our secondary objective was to determine whether providers were more likely to discuss firearms with patients at elevated suicide risk.

Methods: This was a retrospective chart review of primary care well child visits occurring January-December 2019 in a large, urban academic clinic. We documented provider-type and training level (exposure); any documentation of firearms in the chart (counseling, screening) was considered as having a firearm discussion (outcome). We also collected demographics, patient mental health history, PHQ-9 scores, and assessed suicide risk.

Results: Of the 743 charts reviewed, firearms were discussed in 9% (n=66). Medical students were most likely to discuss firearms (15%), attending physicians were least likely (1%, p < 0.001). Providers did not discuss firearms more frequently among youth at elevated suicide risk.

Conclusion: Though providers do not frequently discuss and document firearm discussions overall, the higher rates among medical students is promising. Given the lethality of firearms in a suicide attempt, the lack of firearm safety discussions with those at elevated suicide risk was concerning. Further study should evaluate factors that facilitate discussions in this cohort and identify strategies to improve counseling among more senior providers.

What's new: Pediatric providers have an opportunity to counsel families about the risk of firearm access. We found that trainees are most likely to counsel families about firearms, and that providers are not more likely to counsel youth at elevated suicide risk.

Keywords: Adolescent Medicine; firearm counseling; firearm storage; firearms screening; guns; primary care; well child visits.