Discussions of firearm safety uncommon in the health care setting

Adults who live in households with firearms are unlikely to have ever discussed firearm safety with a clinician, a recent survey found.

Researchers used data from the 2019 National Firearms Survey, conducted online from July to August 2019, to estimate the proportion of adults in gun-owning households who have discussed firearm safety with a clinician, as well as to characterize these encounters. In the survey, adults who had firearms in their homes were asked if a physician or other clinician had ever spoken to them about firearm safety. Those who said yes were asked where the discussion took place (i.e., at an outpatient medical visit, an outpatient mental health visit, in the ED, or in another setting); whether the patient at the encounter was the respondent, another adult, or a child; and what advice was given. The results of the survey were published as a brief report Dec. 22 by Annals of Internal Medicine.

The 2019 National Firearms Survey included 4,030 adults, 4,011 of whom answered all questions related to firearm safety. Of these 4,011 respondents, 52% were men and 48% were women; 76.8% were White. Overall, 7.5% (95% CI, 6.6% to 8.6%) said they had ever discussed firearm safety with a clinician. Such discussions were more common among adults who lived with children versus those who did not (12.0% [95% CI, 9.9% to 14.6%] vs. 5.3% [95% CI, 4.4% to 6.3%]), and most discussions took place during an outpatient medical visit. Almost half of those who reported discussions about firearms (48% [95% CI, 41.1% to 54.9%]) said they had discussed locking all firearms at their most recent visit, 31.8% (95% CI, 23.6% to 38.7%) said that they had discussed storing ammunition separately from firearms, and 15.9% (95% CI, 11.3% to 21.9%) said that the discussion had addressed removing firearms from the home “if you or someone in your family was going through a hard time.” Removal of firearms was less likely to be discussed when the patient who was the subject of the visit was a child (4.1% [95% CI, 1.1% to 9.4%]) than when the patient was the respondent (26.3% [95% CI, 18.0% to 36.7%]) or another adult (55.7% [95% CI, 30.9% to 77.9%]).

The researchers concluded that discussions about firearm safety between patients and clinicians are unlikely in the health care setting. When they did occur, such discussions were most likely to cover safe storage of firearms and least likely to cover removal of firearms from the home. The study focused only on adults currently living in homes with firearms and the results may have been affected by recall bias, the authors noted. “Our study suggests that efforts to date have not adequately promoted firearm safety discussions in clinical settings,” they wrote. “Addressing clinician concerns that these discussions will negatively affect the physician–patient relationship in light of recent evidence that patients are usually open to such conversations may be a good place to start.”