Overcoming Barriers to Firearm Counseling in the Well Child Visit

Purpose/Objectives: Firearms continue to be a significant source of morbidity and mortality among United States children. Primary care providers have the opportunity to provide families with injury prevention education and safety products; however, these discussions infrequently occur due to a lack of confidence about the topic, unavailable resources, or concerns about parental responses. The Ohio AAP conducted a firearm prevention quality improvement (QI) project to overcome barriers, improve provider confidence and increase discussions during well child visits.

Design/Methods: Ohio AAP recruited five primary care practices to pilot their Store it Safe materials. Prior to implementation of the program, a data collection tool, provider talking points, a family survey and pre/post provider confidence assessments were developed. Materials were to be used at every 2-5 year old well-child-care visit. The goal was to document firearm discussions (at least 3/5 or talking points reviewed) at more than 80% of encounters. Gun boxes were provided to be distributed when indicated. Providers submitted at least 10 baseline charts for two consecutive months prior to project participation. After implementing the education, providers submitted at least 5 random chart reviews for patients two to five years of age each month for 5 additional months. Pediatric provider confidence on the topic was assessed at the beginning and end of the program. All providers received MOC 4 credit for participation.

Results: Participating practices submitted a total of 109 baseline forms and 233 forms following implementation of the project. Providers went from discussing firearm safety and storage at no well child visits, to 100% of the well child visits over the course of the Learning Collaborative. (Figure 1) All participating physicians improved their confidence in discussing firearms safety from the beginning to the end of the project. Participants increased their offering of a gun box, when appropriate, from 6% to 95%, while the acceptance of lock boxes remained variable over the course of the collaborative. (Figure 2)

Conclusion/Discussion: Firearm QI programs within pediatric offices can increase discussion and provision of resources to improve firearms safety for small children. The monthly data indicates a notable increase in documentation and discussion of key safe storage topics following the implementation of the project and materials. Provider confidence regarding providing firearms safety resources can be improved with access to lock boxes and handouts on this topic during the program.