Northeastern University, Boston, MA; Harvard Injury Control Research Center, Harvard Chan School of Public Health, Boston, MA.
Northeastern University, Boston, MA.
Ann Emerg Med. 2020 Aug;76(2):194-205. doi: 10.1016/j.annemergmed.2020.02.007. Epub 2020 Apr 16.
We evaluate whether a counseling intervention implemented at the hospital level resulted in safer firearm and medication storage by caregivers of youths aged 10 to 17 years after their child's evaluation in the emergency department (ED) for a behavioral health concern.
We used a stepped-wedge clustered design rolled out at 4 hospital sites to assess primary preregistered outcomes (self-reported storage changes caregivers made to household firearms and medications), assessed by survey 2 weeks after the ED visit. Three logistic models provided estimates of the intervention effect: an unadjusted model, a model with hospital-level fixed effects, and a model that further adjusts for time.
Of the 575 caregiver participants, 208 were firearm owners (123 in usual care, 85 in the intervention). Baseline (pre-ED visit) characteristics did not differ between usual care and intervention phases. During the 2-year study period, twice as many caregivers whose child visited the ED after (compared with before) a hospital adopted the intervention improved firearm storage and 3 times as many improved medication storage (odds ratio [OR]=2.1 [95% confidence interval {CI} 1.0 to ∞] and OR=3.0 [95% CI 2.2 to ∞], respectively). After adjusting for time, the intervention effect for medications persisted (OR=2.0 [95% CI 1.0 to ∞]); the effect on firearms did not (OR=0.7 [95% CI 0.1 to ∞]).
To our knowledge, this study is the first controlled trial to estimate the effectiveness of an intervention on firearm and medication storage in homes of youths at elevated risk of suicide. We found evidence that caregivers' medication storage improved after their child's ED visit, with evidence suggestive of improvement for firearm storage.
我们评估了在医院层面实施的咨询干预措施是否导致了在急诊科（ED）评估行为健康问题后 10 至 17 岁青少年的照顾者更安全地储存枪支和药物。
我们使用了在 4 家医院实施的逐步楔形聚类设计来评估主要的预先注册结果（照顾者在 ED 就诊后 2 周通过调查报告的家庭枪支和药物储存变化）。使用三个逻辑模型提供干预效果的估计值：未经调整的模型、具有医院水平固定效应的模型和进一步调整时间的模型。
在 575 名照顾者参与者中，有 208 名是枪支所有者（123 名在常规护理中，85 名在干预组中）。常规护理和干预阶段之间的基线（ED 就诊前）特征没有差异。在 2 年的研究期间，在医院采用干预措施后（而不是之前）访问 ED 的照顾者中，有两倍多的人改善了枪支储存，有三倍多的人改善了药物储存（比值比[OR]=2.1[95%置信区间{CI}1.0 至 ∞]和 OR=3.0[95% CI 2.2 至 ∞]）。在调整时间后，药物干预效果持续存在（OR=2.0[95% CI 1.0 至 ∞]）；枪支的效果没有（OR=0.7[95% CI 0.1 至 ∞]）。
据我们所知，这是第一项评估干预措施对处于自杀风险增加的青少年家庭中枪支和药物储存的有效性的对照试验。我们发现有证据表明，在他们的孩子接受 ED 就诊后，照顾者的药物储存得到了改善，并且有证据表明枪支储存得到了改善。
