October 09, 2019
Area(s) of Interest: Public Health
A new study out of the University of California, Davis, Firearm Violence Research Center shows that Californians find gun safety conversations that take place in the exam room appropriate if a patient has access to a gun and the patient — or someone in the patient’s home — is at increased risk for firearm-related harm, such as trouble with drug or alcohol misuse.
The study was published in the Oct. 7 in Health Affairs’ special issue on Violence and Health. While previous studies have found public support for health professionals talking with patients about gun safety in general, this study is the first to ask about appropriateness of these conversations in specific risk scenarios.
“Health care providers have unique potential to recognize risk for firearm injury and — when risk is elevated and there’s access to a gun — to talk with patients about safe gun practices,” said lead researcher Rocco Pallin. “But providers infrequently assess risk and engage with patients in these conversations in part because they think patients won’t be receptive or that such discussions may alienate them. Our results suggest that these conversations are broadly acceptable, and that patients may find them most appropriate when there is specific risk.”
Over the past 10 years ending in 2017, fatalities from firearm violence among civilians in the U.S. exceeded combat fatalities in World War II. Firearm homicides have increased by 32% since 2014, suicides by 41% since 2006 and the number of nonfatal crime victims by 37% since 2013.
Interventions for Patients at Acute Risk
Four out of five respondents, regardless of gun ownership status, said it was at least sometimes appropriate for a physician to intervene to reduce firearm injury when a patient with access to a gun had thoughts of self-harm or harming others. Suggested interventions included counseling the patient to have someone else keep the gun and informing the patient’s family.
This study is the first to gauge public opinion on the appropriateness of temporary transfer when someone with access to a gun is in crisis. The high level of support for this intervention, regardless of firearm ownership status, suggests this may be a reasonable risk reduction strategy.
“When someone is suicidal, reducing access to lethal means can be lifesaving, and temporary transfer is one option,” Pallin explained. The authors recommend that providers be informed about relevant statutes, which vary by state, in order to make lawful and realistic recommendations.
Increased attention has been given to the role of health care providers in reducing firearm injuries in the last two years, but Pallin suggests more work needs to be done.
“Clinicians, firearm owners, safety instructors and researchers need to work together to develop and evaluate approaches to assess patient risk, counseling on gun safety when clinically relevant, and intervening in emergency situations. We need to understand what works best for certain types of risk, certain types of providers, and certain types of patients in order to educate providers to most effectively and efficiently work to prevent firearm-related harm,” she said.
The state of California recently appropriated funds to develop clinician training on strategies for firearm injury prevention, which has the potential to become a national model.
For an overview of the study results, see the “Opinions on Health Professionals Talking About Gun Safety” factsheet. The full study is available to Heath Affairs subscribers here.
The California Medical Association (CMA) Firearm Violence Prevention Technical Advisory Committee has identified opportunities and resources that may aid physicians in addressing firearm violence as a public health issue. In addition to a policy statement, the committee compiled a number of ways physicians can help prevent firearm violence.