Kitty O'Hare, Duke University School of Medicine, Cary, NC, United States; Malinda S.. Teague, Duke University School of Nursing, Durham, NC, United States; Tabitha A. Smith, Duke Primary Care, Apex, NC, United States; Lisa Ferrari, Duke University, Durham, NC, United States; Carol Burk, Duke University School of Medicine, Durham, NC, United States; Dean S. Miner, Duke University School of Medicine, Durham, NC, United States; Brian Eichner, Duke University School of Medicine, Raleigh, NC, United States
Senior Medical Director Duke Primary Care Cary, North Carolina, United States
Background: Firearm-related injuries are now the leading cause of death for children and adolescents age 1-19 years, with increased firearm-related deaths and injury reported during the COVID-19 pandemic. Some research suggests that healthcare providers are more likely to perform firearm safety counseling when they receive targeted education and when they are prompted to perform counseling. Objective: In an effort to address this national crisis, we implemented a systematic approach to firearm safety counseling in Duke Primary Care, an academically affiliated network serving children and adults throughout the Triangle region of North Carolina. Design/Methods: A Quality Improvement committee was established with provider and administrator representation. We partnered with firearm safety experts from the Department of Pediatrics and from community organizations. Our partners shared educational resources as well as free cable gun locks from the Veterans Administration. Prompts about firearm safety counseling were added to providers’ standardized Well Visit note templates for ages 0-17 years. These prompts included reporting of whether or not counseling was provided and were enabled with a Smart Data Element to allow tracking through the Electronic Health Record (EHR). Data was collected for one full year of Well Visit encounters and trends of counseling were evaluated over that time. Results: Between 9/1/2021 and 8/31/2022 there were 13,012 visits (49.1 %) for which providers reported performing firearm safety counseling, and 13,468 visits (50.9 %) for which providers reported that they did not counsel. The overall counseling rate decreased somewhat with time, from 53.2% in fall 2021 to 45.8% in summer 2022. Counseling was reported at 29 unique practices, though the frequency of counseling varied significantly by practice. Counseling was slightly more likely for female patients than for male patients. Counseling was more likely to be reported for patients 6-11 years and 12-17 years than for patients 0-5 years. Counseling was more likely to be reported for patients speaking a language other than English, though the absolute number of non-English speakers was low.
Conclusion(s): There has been provider acceptance of firearm safety counseling throughout the Duke Primary Care network. Future goals include expansion to Duke Urgent Care practices, addition of prompts to adult patient templates, additional provider education about firearm safety counseling, and increased detail of counseling provided and capture in the EHR to sustain long-term practice change.
.jpg "Kitty O'Hare, MD (she/her/hers) photo")