‘Nudges’ and some additional staff support help pediatricians implement a safe gun storage program

If it takes a pediatrician less than a minute per visit to talk to parents about how to safely store their firearms and offer a free cable lock, why do only 2% of physicians report doing this routinely?

Apparently, they may just need a ‘push’ and a little extra support.

In the largest study of its kind, scientists from Northwestern University, the University of Pennsylvania, Henry Ford Health and Kaiser Permanente Colorado tested whether pediatricians would make these conversations more often and offer a free cable lock — through an evidence-based program called SAFE firearm– if they have received a ‘Nudge’ or a ‘Nudge+’. The findings were published on September 3 JAMA Pediatrics.

The “Nudge” consisted of a prompt in the physician’s electronic health record (EHR) to remind them to have the conversation with the parents during the child’s visit. In the “Nudge+” scenario, physicians received this reminder through the EHR system and received support from staff employed by their healthcare system who helped solve logistical issues, such as where to store hundreds of cable locks or how to manage conversations with healthcare providers fed.

“We know we can save lives and this study provides insights into how we can scale this approach nationally,” said lead researcher Rinad Beidas, chair of the department of medical social sciences and Ralph Seal Paffenbarger professor of medical social sciences at Northwestern University Feinberg School. of medicine. “This is a call to action.”

The study included 47,307 well-child visits from children ages 5 to 17 at 30 clinics in Michigan and Colorado. In the Nudge group, 22% of pediatricians delivered the SAFE Firearm program, while 49% of pediatricians in the Nudge+ group delivered the program – a significant difference.

“Our clinical staff was very supportive of the program, especially when additional guidance was available,” said Brian Ahmedani, director of the Center for Health Policy & Health Services Research at Henry Ford Health. “Conversations about firearms can be awkward. The support staff helped navigate how and when to introduce the topic and at what point to offer the cable lock.”

On average, each “Nudge+” program required only 8.7 hours of additional support per clinic over the year.

“We expected that we would need a lot more resources for that kind of effect, but with less than an hour per month per clinic, this is something that could be done in the real world without many resources,” Beidas said.

One in three American homes has a firearm

About a third of American children live in homes with firearms, and of these households, 43% have at least one unlocked firearm. Previous research has shown that individuals who have a conversation with their doctor about the importance of safe storage in combination with offering a free cable lock were more likely to improve their safe gun storage practices.

Safely storing guns can reduce firearm-related injuries, which are the leading cause of death for young people in the US. In June, U.S. Surgeon General Vivek H. Murthy said declared America’s gun violence a public health crisis. In his advice, Murthy calls for more implementation research to improve the effectiveness of prevention strategies.

“Our study is the largest of such implementation trials, and I am thrilled that Dr. Murthy is highlighting this type of research,” said Beidas, an internationally recognized leader in implementation science. Her research focuses on designing, implementing, and evaluating strategies to make it easier for physicians, leaders, and organizations to improve health care quality and equity.

Why don’t more pediatricians provide advice on safe firearm storage?

There are numerous reasons why so few pediatricians discuss the safe storage of firearms with parents, Beidas said. Some are time-related or how comfortable the physicians are talking about it, whether it’s built into the workflow, and whether it’s supported by leadership. But it’s also a divisive topic, and doctors and nurses are finding that people don’t feel comfortable sharing if they have a gun at home, Beidas said.

“So our goal is to have pediatricians provide advice to everyone,” she said, explaining that the program is for all children, not just those who are at particular risk, such as depression or exposure to domestic violence. “Our goal is to help people be as safe as possible, as often as they can, and our study shows this can be done in a non-political way.”

Next step: expand nationally

This study was conducted in just two states, but Beidas said her goal is to expand the effort nationally. First, she wants to demonstrate empirically that these types of national efforts reduce firearm injuries and deaths among young people. Second, she plans to expand this work beyond pediatric primary care into other health care settings.

“Our measure of the effectiveness of this study was whether the physicians implemented the program, but that is not the final step of the cascade,” Beidas said. “We will have papers in the future examining whether the parents have actually changed their behavior in storing firearms.”