286 A Systematic Review of Clinician Attitudes, Screening Practices, and Interventions to Reduce Firearm-Related Injury

Ameli, J., Roszko, P. J. D., Carter, P. M., Haynes, C., Cunningham, R., & Ranney, M. L. (2015). 286 A Systematic Review of Clinician Attitudes, Screening Practices, and Interventions to Reduce Firearm-Related InjuryAnnals of Emergency Medicine66(4), S103.

Study Objectives: To systematically identify and summarize the existing health care literature on clinical firearm screening/interventions for patients of all ages, among all clinical specialties.

Methods: A systematic search of 4 databases (PubMed, WebOfScience, CINAHL, Psycinfo) and Clinicaltrials.gov was conducted in October 2014. English-language original research on any clinician firearm screening or interventions, or patient/provider attitudes on the same, was included. Two authors independently completed title and abstract review to exclude unrelated studies (editorials, reviews, studies in the justice and education systems). The remaining studies underwent full-text review, structured data abstraction, and quality scoring using the Newcastle-Ottawa Scale (NOS), modified NOS or JADAD by 4 study authors. Discrepancies were resolved by group consensus.

Results: A total of 3260 unique titles were identified and 72 were included (434 excluded by using limits English and human, 1264 excluded at title review, 1463 at abstract review, 27 at full-text review). Fifty-three studies examined clinician attitudes and practice patterns. Screening rates for firearm risk were low across most studies and specialties (emergency, pediatrics, psychiatry, family medicine). Clinicians’ prior training, experience, and expectations correlated with regularity of firearm screening and likelihood of giving anticipatory guidance. Seven articles described patient attitudes, with mixed results on patient willingness to discuss firearm safety. Twelve articles assessed interventions for at-risk populations, of which 2 were high-quality RCTs; a parent counseling intervention increased parents’ rates of safe firearm storage; a collaborative care intervention for traumatically injured youth reduced teens’ 12-month weapon carriage. Overall, study quality was poor. Common limitations included small sample sizes, low response rates and high loss-to-follow-up, use of proxy outcome measures, and reliance on non-validated self-report measures, subject to social desirability and recall bias.

Conclusion: Existing clinical firearm injury prevention research largely focuses on clinician attitudes and practice patterns, with limited evidence regarding effective practices to decrease firearm injury. Methodological quality is generally poor. The few high-quality studies suggest that clinician firearm screening and interventions may be acceptable to patients and providers, and may reduce youth risk of firearm injury. Further research is needed to establish best screening and intervention practices.

Keywords: Healthcare literature, firearm screenings, violence intervention