Promoting Safe Gun Storage Among Veterans to Prevent and Reduce Gun-Related Suicide and Accidents: a VA Resident Clinic Pilot Initiative 

From the 2023 HVPA National Conference

Mitchell Dittus, Doctor of Medicine (Stony Brook University Hospital), Pronoma Srivastava, Doctor of Medicine, Lisa Fisher, Doctor of Medicine

Background:
United States (U.S.) veterans are more likely to own a firearm, use it in a suicide attempt, and die by suicide compared to their civilian counterparts. The U.S. Department of Veterans Affairs (VA) has implemented a multimodal approach to reduce veteran related firearm deaths, including improving safe firearm storage with the availability of free gun locks. A properly secured firearm can limit firearm-related fatalities during a suicidal crisis.

Objective:
To increase firearm safety screening and gun lock distribution. Methods We distributed an anonymous, electronic survey to residents in our primary care clinic to determine how frequently the subjects of firearm ownership and safety were discussed with patients, and to assess knowledge of current securement programs at the VA. We then developed an electronic gun safety reminder in the EMR to encourage routine documentation of firearm ownership, firearm storage safety, and the distribution of gun locks (figure 1). We promoted our initiative to veterans by displaying posters throughout the clinic (figure 2). Following success in our clinic, we expanded our reminder to other satellite clinics across Long Island.

Results:
Our survey was completed by 40 of 48 residents. Of the respondents, 87.5% reported never asking veteran patients about possessing firearms, 12.5% reported sometimes asking, and 0% reported always asking. Of respondents, 45% reported being not at all comfortable discussing gun ownership and safety, 50% somewhat, and 5% very comfortable. All residents surveyed were not aware of gun securement programs. Our newly created reminder has been used to screen 14,308 patients. Of those screened, 2,212 reported having access to firearms. Of those with access, 1,128 requested gun locks. We have distributed over 3000 locks to veterans so far. Prior to our initiative there were zero locks distributed.

Conclusions:
Firearm safety and storage was not a routine part of primary care screening in our clinic. There was an overwhelming lack of knowledge on VA firearm securement programs and gun lock availability amongst our providers. The prevalence of firearm ownership in our patient population is 15.5%. Firearm screening was well received, with 51% of gun owners accepting gun locks.

Clinical Implication:
Creation of an EMR reminder increased the incidence of routine primary care firearm screening, the opportunity to discuss safe storage and handling, and the distribution of free firearm locks. In the future we hope to expand our novel EMR reminder to other VA institutions across the United States.

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