Guns, Doctors and Public Health

Feldman, Mitchell D.

doi:10.1007/s11606-016-3822-z

Cited by 1 publication

(1 citation statement)

References 5 publications

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“…15 While firearm-related injuries and deaths are a public health problem, particularly in the US, 16 a minority of physicians report engaging in firearm counseling. 17 Despite several groups having recommended both targeted and universal screening for firearm access, [17][18][19][20][21][22][23][24] there are no current national guidelines for screening in primary care, urgent care or emergency care settings even though gun safety is associated with lower risk of injuries and death. 25,26 To understand how current practice may be adapted, more information on the frequency with which healthcare providers document firearm screening is needed.…”

Section: Introductionmentioning

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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