“Lock to Live” for firearm and medication safety: Feasibility and acceptability of a suicide prevention tool in a learning healthcare system

Abstract

ObjectiveFew patients with suicide risk are counseled on lethal means safety by health providers. This study tested the feasibility of different delivery methods for Lock to Live (L2L), a web-based decision aid of safe storage options for firearms and medications.MethodsPatients reporting suicide ideation on the PHQ9 depression screener during outpatient health visits were included. Invitation messages to visit L2L were sent via combinations of email, text, Electronic Health Record (EHR) message, mailed letter, or provider referral, followed by a survey about storage behavior and acceptability. Provider interviews evaluated logistical considerations and acceptability.ResultsThe population-based method reached 2,729 patients and the best method (EHR message plus 2 email reminders) had 11% uptake (L2L visitation rate). Provider referral had small reach (14 patients) and 100% uptake (all visited). Provider interviews identified several strategies to promote uptake including: EHR reminders, provider training, quality metrics with accountability, a clearly communicated lethal means screening/counseling policy, and strong organizational leadership support.ConclusionDespite the low uptake for population-based (11%), far more patients with suicide risk were engaged in the L2L tool through population-based outreach than provider-referral over the same time frame.

Reducing Firearm Access for Suicide Prevention: Implementation Evaluation of the Web-Based “Lock to Live” Decision Aid in Routine Health Care Encounters

“…Consistent with international design standards [ 23 24 ], the L2L decision aid steps users through various considerations regarding in-home and out-of-home firearm storage options, such as types of storage, costs of storage, and background check requirements, with a goal of encouraging storage solution discussions that are consistent with the users’ values and preferences [ 22 ]. Two subsequent research studies demonstrated promising results for the feasibility and acceptability of offering L2L emergency care encounters [ 25 ] and for the uptake of L2L when it was offered via secure patient portal messages after outpatient care encounters [ 26 ]. Though L2L appears to be a useful tool for supporting suicide prevention in clinical practice, little is known about how to use L2L during routine health care encounters outside of a research context.…”