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Do Clinicians Follow Guidelines on Firearm Safety Counseling?

Shari Barkin, MD; Naihua Duan, PhD; Arlene Fink, PhD; Robert H. Brook, MD; Lillian Gelberg, MD

Arch Pediatr Adolesc Med. 1998;152:749-756.

Objectives  To describe clinicians' behavior regarding firearm safety counseling practices, develop a model to predict current counseling behavior, and identify resources that might positively influence willingness to counsel according to medical guidelines.

Design  Four hundred sixty-five primary care Los Angeles County, California, pediatricians, family physicians, and pediatric nurse practitioners who serve families with children aged 5 years and younger received mailed questionnaires; 325 (70%) responded.

Main Outcome Measure  Clinician self-reported behavior.

Results  Of the respondents, 80% stated that they should counsel on firearm safety; only 38% do so. Of those clinicians who currently counsel, only 20% counsel more than 10% of their patient families. Firearm safety counseling behavior is positively associated with a clinician being 49 years or younger (odds ratio [OR]=2.19, P=.02); a perception that counseling is beneficial (OR=2.62, P =.02); and household handgun ownership (OR=2.47, P=.02). Clinician households that report gun ownership counsel differently than those clinicians who report not possessing a household gun. There are no significant differences in the rates of counseling across specialties and crime area types. Forty-one percent of clinicians report that patient education handouts would increase their likelihood of counseling.

Conclusions  In Los Angeles County gaps exist between clinicians' views of the benefits of counseling families with young children regarding firearm safety and their actual behavior. Guidelines and handouts are available from major medical organizations. Research should focus on how to get practitioners to use available materials, enabling them to better adhere to guidelines.

From the University of California, Los Angeles (Drs Barkin, Fink, and Gelberg) and the RAND Corporation, Santa Monica, Calif (Drs Duan and Brook).

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