The purpose of this study was to determine whether utilizing the electronic medical records to inform healthcare providers (HCPs) of the presence of firearms in the home increased HCP recognition of the presence of firearms, as well as increased the delivery of a firearm safe storage message to parents.
Firearms are now the leading contributor to adolescent mortality. Studies done in primary pediatric settings demonstrate that counseling families and distributing safe storage devices increase safe storage of firearms; however, health care providers (HCPs) infrequently screen for and/or address firearm safety. Youth scheduled for a routine physical or a mental health visit were prescreened for the presence of household firearms. If youth and/or parent indicated that a firearm was present, they were eligible to participate in the study. Youth were randomized to one of three groups: 1) Control (HCP not notified electronically of firearm presence) 2) Means Restriction Counseling (MRC) Only - HCPs notified via chart messaging that youth screened positive for firearms or 3) MRC + distribution of safe storage devices (MRC +SSD). A chart review was conducted to determine whether the HCP documented the presence of firearms, and whether counseling was delivered. Parent recollection of the visit was done one week after the visit. T-tests were used to analyze results. The study was approved by the Colorado Multiple Institutional IRB. A total of 1,336 youth/parent dyads were screened; 139 (10.4 percent) reported the presence of firearms, and 76 (54.5 percent) agreed to participate and were enrolled. Youth study population were 34 percent male, 63 percent White, 18 percent Black, and 32 percent Latino. Insurance status: 45.4 percent public, 54.5 percent commercial. Thirty percent were assigned the control group, and 41 percent to MRC, and 29 percent to MRC + SSD. HCPs delivered means restriction counseling to 15 percent of families in the control group, compared to 52.2 percent in the combined intervention groups (p=.009). HCPs documented the existence of firearms in the home in 50 percent of the control group compared to 58.7 percent of the combined intervention groups (p= .38). At one-week follow-up, 33 percent of control parents, 62 percent of MRC parents and 40 percent of MRC + SSD recalled hearing a message about safe storage/means restriction counseling; however, 90 percent of parents in which their child received a mental health diagnosis reported hearing a safe storage discussion, regardless of group assignment. Removing youth with a mental health diagnosis from the analysis, 53 percent of parents in the intervention groups recalled a safe storage message compared to none in the control group (p=.005). The study concluded that pre-screening families for firearm access and embedding the results in the electronic medical record greatly enhanced the delivery of a firearm safe storage message by health care providers. (publisher abstract modified)