Veterans Are Agreeable to Discussions About Firearms Safety in Primary Care

Newell, Summer; Kenyon, Emily A.; Clark, Khaya D.; Elliott, Victoria; Rynerson, Annabelle; Gerrity, Martha; Karras, Elizabeth; Simonetti, Joseph A.; Dobscha, Steven K.

doi:10.3122/jabfm.2021.02.200261

Cited by 17 publications

(29 citation statements)

References 36 publications

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“…In this study, military veterans were ranked as one of the best groups of messengers. Alternatively, our and others' prior work on rearms safety (20,24,26,46) suggests that rearms safety messaging by clinical staff is acceptable to veterans, when done respectfully.…”

Section: Discussionmentioning

confidence: 98%

“…The methods and ndings from the focus group meetings and individual interviews with veterans and staff have previously been published (24)(25)(26). Table 1 shows a summary of ndings regarding attitudes and advice given by these stakeholders which speci cally informed development of the training program.…”

Section: Development Of the Training Programmentioning

confidence: 99%

“…Our research has demonstrated that both primary care teams and veterans support having FSS discussions during primary care visits, with certain caveats (24)(25)(26). The purpose of this manuscript is to 1) describe stakeholder-informed development of an education program to help primary care teams discuss FSS during primary care visits; and 2) present results of a preliminary evaluation of the pilot program.…”

Section: Introductionmentioning

confidence: 99%

“…The authors also acknowledge and appreciate the efforts made by the Health Services Research and Development (HSR&D) Centralized Transcription Service Program (CTSP) to complete transcription of all interviews for this project. Summary of Themes from Development Phase(24)(25)(26)…”

mentioning

confidence: 99%

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Development and Preliminary Evaluation of an Education Program for Primary Care Teams on Discussing Firearms Storage Safety with Veterans

Dobscha¹,

Clark

Karras³

et al. 2021

Preprint

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Background Reducing access to lethal means is one of the few empirically supported approaches for lowering suicide rates, and safe firearms storage practices have been associated with reduced risk of death by suicide. Although there is substantial opportunity for primary care to assist in addressing lethal means with veterans, approaches to intervention and educating staff are not well documented. We sought to 1) describe development of an education program for primary care teams to help them discuss firearms storage safety (FSS) with veterans during primary care visits; and 2) conduct a preliminary evaluation of the pilot education program. Methods We used an iterative process involving veterans and primary care staff stakeholders to develop program content, format, and supplemental materials. A grounded theory approach was used to analyze data from focus groups and individual interviews. Following piloting of the program with 71 staff members in two primary care clinics, we analyzed pre- and post-training participant surveys of program satisfaction and attitudes and behaviors related to firearms safety. Results During the development phase, 68 veterans and 107 staff members participated in four veteran focus groups and four primary care focus groups, respectively, and/or individual interviews. The program that was developed, “’Just in Case’: Discussing means safety with veterans at elevated risk for suicide,” addresses knowledge and skills learning objectives, and includes video demonstrations and skills practice. Survey data obtained just prior to the two pilot training sessions showed low self-reported rates of discussing firearms safety with veterans who may be at elevated risk for suicide. Immediate post-training data showed generally high satisfaction with the program and significant improvements in participant self-reported ratings of the importance of, and comfort with FSS. Conclusions The program shows promise as a means for educating primary care staff to deliver messaging about firearms safety to veterans. Additional research is needed to refine and evaluate impacts of this or similar training programs on clinician and veteran behaviors over time.

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Section: Discussionmentioning

confidence: 98%

Section: Development Of the Training Programmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Development and Preliminary Evaluation of an Education Program for Primary Care Teams on Discussing Firearms Storage Safety with Veterans

Dobscha¹,

Clark

Karras³

et al. 2021

Preprint

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“…Multiple prior studies have clearly demonstrated that firearm owners, including veteran firearm owners, agree that clinicians have a role in firearm safety counseling among at-risk individuals. 21 , 26 , 27 , 47 …”

Section: Discussionmentioning

confidence: 99%

Development and Preliminary Evaluation of an Education Program for Primary Care Teams on Discussing Firearms Storage Safety with Veterans

Dobscha

Clark

Karras

et al. 2022

Journal of Medical Education and Curricular Development

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Background Reducing access to lethal means is one of the few empirically supported approaches for lowering suicide rates, and safe firearms storage practices have been associated with reduced risk of death by suicide. Although there is substantial opportunity for primary care to assist in addressing lethal means with veterans, approaches to intervention and educating staff are not well documented. We sought to 1) describe development of an education program for primary care teams to help them discuss firearms storage safety (FSS) with veterans during primary care visits; and 2) conduct a preliminary evaluation of the pilot education program. Methods We used an iterative process involving veterans and primary care staff stakeholders to develop program content, format, and supplemental materials. A grounded theory approach was used to analyze data from focus groups and individual interviews. Following piloting of the program with 71 staff members in two primary care clinics, we analyzed pre- and post-training participant surveys of program satisfaction and attitudes comfort related to firearms safety discussions. Results During the development phase, 68 veterans and 107 staff members participated in four veteran focus groups and four primary care focus groups, respectively, and/or individual interviews. The program that was developed, “‘ Just in Case’: Discussing means safety with veterans at elevated risk for suicide,” addresses knowledge and skills learning objectives, and includes video demonstrations and skills practice. Survey data obtained just prior to the pilot training sessions showed low self-reported rates of discussing firearms safety with veterans who may be at elevated risk for suicide. Immediate post-training data showed generally high satisfaction with the program and significant improvements in participant self-reported ratings of the importance of, and comfort with FSS. Conclusions This interactive knowledge and skill-based means safety curriculum shows promise as a means for educating primary care staff to deliver messaging about firearms safety to veterans. Additional research is needed to refine and evaluate impacts of this or similar training programs on clinician and veteran behaviors over time.

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Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

et al. 2022

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ImportanceUS residents report broad access to firearms, which are the most common means of suicide death in the US. Standardized firearm access questions during routine health care encounters are uncommon despite potential benefits for suicide prevention.ObjectiveTo explore patient and clinician experiences with a standard question about firearm access on a self-administered mental health questionnaire routinely used prior to primary care and mental health specialty encounters.Design, Setting, and ParticipantsQualitative semistructured interviews were conducted from November 18, 2019, to October 8, 2020, at Kaiser Permanente Washington, a large integrated care delivery system and insurance provider. Electronic health record data identified adult patients with a documented mental health diagnosis who had received a standard question about firearm access (“Do you have access to guns? yes/no”) within the prior 2 weeks. A stratified sampling distribution selected 30% who answered “yes,” 30% who answered “no,” and 40% who left the question blank. Two groups of clinicians responsible for safety planning with patients at risk of suicide were also sampled: (1) licensed clinical social workers (LICSWs) in primary and urgent care settings and (2) consulting nurses (RNs).Main Outcomes and MeasuresParticipants completed semistructured telephone interviews, which were recorded and transcribed. Directive (deductive) and conventional (inductive) content analyses were used to apply knowledge from prior research and describe new information. Thematic analysis was used to organize key content, and triangulation was used to describe the intersections between patient and clinician perspectives.ResultsThirty-six patients were interviewed (of 76 sampled; mean [SD] age, 47.3 [17.9] years; 19 [53%] were male; 27 [75%] were White; 3 [8%] were Black; and 1 [3%] was Latinx or Hispanic. Sixteen participants had reported firearm access and 15 had reported thoughts of self-harm on the questionnaire used for sampling. Thirty clinicians were interviewed (of 51 sampled) (mean [SD] age, 44.3 [12.1] years; 24 [80%] were female; 18 [60%] were White; 5 [17%] were Asian or Pacific Islander; and 4 [13%] were Latinx or Hispanic) including 25 LICSWs and 5 RNs. Key organizing themes included perceived value of standardized questions about firearm access, challenges of asking and answering, and considerations for practice improvement. Clinician interview themes largely converged and/or complemented patient interviews.Conclusions and RelevanceIn this qualitative study using semistructured interviews with patients and clinicians, a standardized question about firearm access was found to encourage dialogue about firearm access. Respondents underscored the importance of nonjudgmental acknowledgment of patients’ reasons for firearm access as key to patient-centered practice improvement.

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Veterans Are Agreeable to Discussions About Firearms Safety in Primary Care

Cited by 17 publications

References 36 publications

Development and Preliminary Evaluation of an Education Program for Primary Care Teams on Discussing Firearms Storage Safety with Veterans

Development and Preliminary Evaluation of an Education Program for Primary Care Teams on Discussing Firearms Storage Safety with Veterans

Development and Preliminary Evaluation of an Education Program for Primary Care Teams on Discussing Firearms Storage Safety with Veterans

Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

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