Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2018 Nov 2;1(7):e185309. doi: 10.1001/jamanetworkopen.2018.5309.
The rate of youth suicide has increased steadily over the past several decades due, in part, to an increase in suicide by firearm. Implementation of evidence-based approaches to increase safe firearm storage practices are important for reducing youth suicide.
To assess the needs of stakeholders who would be affected by implementing an evidence-based approach to firearm safety promotion-Firearm Safety Check, which includes screening for the presence of firearms in the home, brief motivational interviewing-informed counseling regarding safe firearm storage, and provision of free firearm locks-in pediatric primary care settings.
DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, 58 stakeholders were interviewed over a 7-month period across 9 stakeholder groups from 2 large and diverse health systems. Participants included parents of youth; physicians; nurses and nurse practitioners; leaders of pediatric primary care practices, behavioral health, and quality improvement; system leaders; third-party payers; and members of national credentialing bodies. Data analysis were conducted from September 2017 to April 2018.
Interview guides were informed by the Consolidated Framework for Implementation Research. An integrated analysis approach was used in which a priori attributes of interest were identified (Consolidated Framework for Implementation Research constructs, eg, intervention characteristics), and an inductive approach was used with regard to new themes that emerged.
A total of 58 stakeholders were interviewed (mean [SD] age, 48.38 [10.65] years; 27 men and 31 women). Stakeholders indicated that firearm safety promotion is a health system priority and reported favorable perceptions of the Firearm Safety Check approach for suicide prevention. The importance of leveraging existing infrastructures, such as electronic health record systems and brevity, were frequently noted. Distribution of firearm locks was endorsed as the most complicated component to implement.
By including multiple service system stakeholder perspectives, these results support the development of implementation strategies to change clinician, organization, and system behaviors around firearm safety promotion in pediatric primary care as a universal suicide prevention strategy.
由于枪支自杀率的上升，过去几十年青少年自杀率稳步上升。实施基于证据的方法来增加安全的枪支储存措施对于减少青少年自杀非常重要。
评估受实施基于证据的枪支安全促进方法（枪支安全检查）影响的利益相关者的需求，该方法包括在家中筛查枪支的存在，针对安全枪支储存进行简短的动机访谈知情咨询，并在儿科初级保健环境中提供免费的枪支锁。
设计、设置和参与者：在这项定性研究中，在 2 个大型和多样化的医疗系统中，跨越 9 个利益相关者群体，在 7 个月的时间内对 58 名利益相关者进行了访谈。参与者包括青少年的父母；医生；护士和执业护士；儿科初级保健、行为健康和质量改进的领导者；系统领导者；第三方付款人；以及国家认证机构的成员。数据分析于 2017 年 9 月至 2018 年 4 月进行。
访谈指南由实施研究综合框架提供信息。使用了综合分析方法，其中确定了预先确定的感兴趣属性（实施研究综合框架结构，例如干预措施特征），并对出现的新主题使用了归纳方法。
共访谈了 58 名利益相关者（平均[SD]年龄，48.38[10.65]岁；27 名男性和 31 名女性）。利益相关者表示，枪支安全促进是医疗系统的重点，并对预防自杀的枪支安全检查方法表示了有利的看法。经常提到利用现有基础设施（例如电子健康记录系统和简洁性）的重要性。枪支锁的分配被认为是实施最复杂的部分。
通过包括多个服务系统利益相关者的观点，这些结果支持制定实施策略，以改变儿科初级保健中枪支安全促进方面的临床医生、组织和系统行为，作为普遍的自杀预防策略。
