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Few physicians ask patients about firearm access

Article

Study examines screenings, patient demographics, and primary care as gun violence grows as a public health concern.

Relatively few physicians are asking their patients about firearm access, despite guns contributing to public health concerns across the United States.

A new study examined how many doctors and health care providers screen their patients for firearm access, and which patients have been screened in the past. The results: 17.1% of participating patients said they were asked about gun access, although numbers were higher in mental health care settings and for patients with children aged 17 years or younger in the house.

“Overall, health care providers are rarely screening for firearm access,” the study said. “It may be that providers do not feel it is their responsibility to discuss firearms, do not know how to promote safe storage, or are uncomfortable with the topic.”

The authors noted research has not shown conclusively that safe gun storage cuts down on injuries and deaths, but evidence supports the potential for that approach.

Primary care also may be a key arena for screening. Among those who die by suicide, 26.6% had mental health or substance abuse treatment. But 83% had some form of health care in the year before death, meaning physicians and other providers can provide information about safe gun storage to the majority of those who died by suicide, the study said.

“Although we know that firearm access increases the risk for fatal injury for everyone in the home, health care providers are rarely asking about firearm access,” lead author Allison Bond said in a news release. Bond is a doctoral student at the New Jersey Gun Violence Research Center at Rutgers University.

“In order to prevent these injuries and deaths, health care providers need consider adding screening for firearm access into standard practice so that they are better positioned to then provide resources on secure firearm storage to the families that would most benefit from that information,” Bond said.

The report, “Determining who healthcare providers screen for firearm access in the United States,” was published this month in the journal Preventive Medicine. For years, physicians groups have advocated for lawmakers to enact stricter policies in hopes of reducing gun deaths across the nation.

Who gets asked

Researchers surveyed 3,510 adults in Colorado, Minnesota, Mississippi, New Jersey, and Texas, in April and May 2022. The researchers asked about suicidal ideation, mental health treatment, current gun ownership, and whether physicians or other providers ever asked if they had access to firearms.

It was clear health care providers asked some groups more frequently. For example, they asked:

  • 20.1% of patients with children aged 17 years and younger
  • 25.5% of those who had received mental health treatment
  • 23.7% of those with suicidal ideation
  • 21.4% of firearm owners

The last figure meant doctors and clinicians accurately identified at least some firearm owners. White males also had a greater chance of being asked, according to the study. Even among those groups with greater likelihood of screening, the researchers noted most of the patients were never asked.

The results varied by the state, with Minnesota having the highest screening rate (31.2%), followed by Colorado (22.7%), Mississippi and Texas (13%), and New Jersey (10%).

Getting started

The researchers called for all health care providers to screen for firearm access. It is an additional burden for physicians and health care workers, but could be integrated with commonly used forms and questionnaires.

For example, providers usually use a single yes-or-no question to screen for smoking, and if the answer is yes, offer more information. A similar method could be an inexpensive way to add firearm screening to all health care settings, the study said.

The American Academy of Pediatrics was the first major health organization to recommend routine screening for gun access for parents. Other medical groups should develop guidelines for their members, the study said.

Lock2Live and the National Shooting Sports Foundation offer free online resources to learn about safe storage practices.

“Finally, health care providers skillfully discussing firearm access with all clients may help to destigmatize and depoliticize conversations about firearms, which may help change social norms and promote a climate where safe firearm storage can be discussed openly,” the study said.

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