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Citation
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Ladines-Lim J, Secrest K, Pu A, Sifuentes A, Spranger E, Stojan J, Meddings J. J. Gen. Intern Med. 2023; ePub(ePub): ePub. |
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Abstract
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INTRODUCTION
The American College of Physicians (ACP) advocates that physicians perform firearm screening and safety counseling (e.g., best storage practices),1 for which there exists relevant guidance.2, 3 However, it remains unclear how often internal medicine (IM) providers perform this and perceive this recommendation.4 At our institution, we surveyed IM outpatient providers and retrospectively reviewed charts for new patients' health maintenance exam (HME) documentation, including routine pre-visit questionnaires containing firearm screening.
METHODS
Our institution is a large, suburban academic tertiary center that serves Michigan and much of the surrounding region. In June 2022, as part of an IM resident-driven quality improvement project, we surveyed IM residents and primary care faculty through convenience sampling regarding firearm safety counseling, including prior training; frequency viewing and addressing patient responses to the firearm access pre-visit screening question, provided to all new patients; and comfort level and sense of responsibility regarding the issue. Notably, no curriculum on firearm safety for internists existed at our institution at the time of the survey.
We also retrospectively reviewed charts of all new HME visits in May 2022 at all IM primary care clinics, using a standardized abstraction form to assess the following: firearm access screening pre-visit responses provided by patients (paper or online); history of psychiatric or substance use disorder (SUD) given the ACP's position that this be included in background checks for anyone purchasing firearms;1 and any documentation of counseling.
The University of Michigan Medical School Institutional Review Board assessed this study as non-research and waived ethics approval requirements.
RESULTS
Representing 10 clinic sites, 109 of 226 providers (43% faculty, 57% residents) completed the survey (48% response rate). Among providers, 32% were unaware of the pre-visit screening question and 89% had no related training. Self-reported practice, comfort, and perceived importance of the issue were variable (Table 1). During HME visits, 61% sometimes or never address firearm safety; only 36% felt comfortable doing so. The issue was considered at least very important to address by 39%, while 32% felt it was slightly or not at all important. Although 45% agreed firearm safety falls within their role, 33% disagreed. Most felt more likely to address the issue in patients with mental illness and SUD. Barriers to addressing firearm safety included lack of training and time constraints...
Language: en |