Points of Influence for Lethal Means Counseling and Safe Gun Storage Practices

Runyan, Carol S. Wolf; Brooks‐Russell, Ashley; Betz, Marian E.

doi:10.1097/phh.0000000000000801

Cited by 7 publications

(3 citation statements)

References 24 publications

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“…Further, provider unfamiliarity with lethal means restriction as a firearm suicide prevention strategy may prohibit uptake of screening and counseling. 17 , 23 , 37 – 39 These barriers indicate a need for increased training of healthcare providers on firearm screening and safety counseling and normalizing the opportunities to discuss firearms in a population that has higher rates of firearm ownership and use.…”

Section: Discussionmentioning

confidence: 99%

Documentation of Screening for Firearm Access by Healthcare Providers in the Veterans Healthcare System: A Retrospective Study

Brandt¹,

Workman²,

Farmer³

et al. 2021

WJEM

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Introduction Presence of a firearm is associated with increased risk of violence and suicide. United States military veterans are at disproportionate risk of suicide. Routine healthcare provider screening of firearm access may prompt counseling on safe storage and handling of firearms. The objective of this study was to determine the frequency with which Veterans Health Administration (VHA) healthcare providers document firearm access in electronic health record (EHR) clinical notes, and whether this varied by patient characteristics. Methods The study sample is a post-9–11 cohort of veterans in their first year of VHA care, with at least one outpatient care visit between 2012–2017 (N = 762,953). Demographic data, veteran military service characteristics, and clinical comorbidities were obtained from VHA EHR. We extracted clinical notes for outpatient visits to primary, urgent, or emergency clinics (total 105,316,004). Natural language processing and machine learning (ML) approaches were used to identify documentation of firearm access. A taxonomy of firearm terms was identified and manually annotated with text anchored by these terms, and then trained the ML algorithm. The random-forest algorithm achieved 81.9% accuracy in identifying documentation of firearm access. Results The proportion of patients with EHR-documented access to one or more firearms during their first year of care in the VHA was relatively low and varied by patient characteristics. Men had significantly higher documentation of firearms than women (9.8% vs 7.1%; P < .001) and veterans >50 years old had the lowest (6.5%). Among veterans with any firearm term present, only 24.4% were classified as positive for access to a firearm (24.7% of men and 20.9% of women). Conclusion Natural language processing can identify documentation of access to firearms in clinical notes with acceptable accuracy, but there is a need for investigation into facilitators and barriers for providers and veterans to improve a systemwide process of firearm access screening. Screening, regardless of race/ethnicity, gender, and age, provides additional opportunities to protect veterans from self-harm and violence.

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Section: Discussionmentioning

confidence: 99%

Documentation of Screening for Firearm Access by Healthcare Providers in the Veterans Healthcare System: A Retrospective Study

Brandt¹,

Workman²,

Farmer³

et al. 2021

WJEM

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“…In 2015, 8 professional medical health associations published a statement supporting the value of lethal means safety counselling in reducing firearm-related deaths. 4 Such conversations may be the last opportunity to intervene before a suicide attempt-64% of people who attempt suicide have seen a health care professional within the month before the attempt.…”

Section: Lethal Means Safety In Veteran Populationsmentioning

confidence: 99%

To Prevent Suicide Among Veterans, Their Physicians Should Discuss Gun Safety

2020

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In mid-October, President Trump signed the Commander John Scott Hannon Veterans Mental Health Care Improvement Act, drawing praise from veterans and their families. The law memorializes former Navy SEAL Commander Hannon, a veterans' mental health care advocate who committed suicide in 2018, and seeks to reduce the suicide rate among veterans. It increases oversight of the US Department of Veterans Affairs' (VA) mental health and suicide prevention programs and allocates $174 million for these programs from 2021 through 2025. Among other strategies, the law funds research into the role of benzodiazepines and opioids in veteran suicides and mandates an efficacy analysis of VA antisuicide campaigns. It also requires that the VA and the Department of Defense (DOD) issue an update to the VA/DOD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide.The new law takes big steps in the right direction but does not address key aspects of the problem: the unique role of firearms in the veteran suicide epidemic, the importance of lethal means safety counseling for at-risk veterans, and the need for VA clinicians to receive training in effectively and sensitively talking with veterans at risk of suicide about firearms, as an expert policy roadmap has recommended. 1 Despite these omissions, earlier this month the VA mandated that all Veterans Health Administration health care practitioners complete a lethal means safety course within 90 days as part of its Suicide Prevention Now initiative. This is a critical advance in VA suicide prevention efforts for many reasons.Author affiliations and article information are listed at the end of this article.

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“…While many countries rely on legal interventions to address firearm safety broadly (e.g., for safe storage, training for owners, and mental health related restrictions on access) ( 1 ), there are considerable political roadblocks to firearm legislation in the United States. Therefore, the health care setting has become an important avenue to deliver public health interventions to increase firearm safety for patients at risk of suicide ( 4 ). Lethal means counseling is recommended ( 5 ) and involves reducing access to common lethal means during suicidal crises.…”

Section: Introductionmentioning

confidence: 99%

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

Boggs

Quintana

Beck

et al. 2022

Front. Digit. Health

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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.

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Points of Influence for Lethal Means Counseling and Safe Gun Storage Practices

Cited by 7 publications

References 24 publications

Documentation of Screening for Firearm Access by Healthcare Providers in the Veterans Healthcare System: A Retrospective Study

Documentation of Screening for Firearm Access by Healthcare Providers in the Veterans Healthcare System: A Retrospective Study

To Prevent Suicide Among Veterans, Their Physicians Should Discuss Gun Safety

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

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