VA Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA.
Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
J Gen Intern Med. 2021 Jun;36(6):1492-1502. doi: 10.1007/s11606-020-06412-x. Epub 2021 Jan 26.
Two-thirds of veteran suicides are attributable to firearm injury. Although half of veterans who die by suicide are seen in primary care settings in the month prior to death, little is known about how to promote firearm safety within primary care.
Describe veterans' perspectives on discussing firearms storage safety (FSS) during primary care visits, and identify key strategies for primary care teams to use in discussing FSS with veterans at elevated risk for suicide.
Qualitative analysis of transcripts and notes from four veteran focus groups and from individual semi-structured interviews with six veterans.
Altogether, 68 veterans participated. Three of the groups were associated with one Veterans Health Administration facility. Groups were diverse in age, service era, and gender.
The goals of the focus groups and interviews were to assess acceptance of FSS discussions during primary care visits, identify facilitators and barriers to conducting FSS discussions, and identify strategies for primary care teams to use to effectively conduct FSS discussions. Transcripts and meeting notes were analyzed using a grounded theory approach.
There was general acceptance of having FSS discussions in primary care. Yet, most veterans did not support direct questioning about firearm ownership, which may trigger fears of having firearms taken away or limit access to firearms. Participants recommended primary care teams provide rationale for FSS discussions and be prepared to provide information on legal consequences of disclosing firearm ownership. Strategies suggested for primary care staff also included using a personalized, caring, and conversational approach rather than highly scripted or checklist approach, engaging veterans in a non-judgmental manner, and conveying respect for veterans' knowledge of firearms.
Discussing FSS with veterans in primary care settings is a promising upstream approach that can complement other suicide prevention efforts, but must be conducted in a veteran-centric manner.
三分之二的退伍军人自杀可归因于枪支伤害。尽管有一半自杀身亡的退伍军人在死亡前一个月曾在初级保健机构就诊，但对于如何在初级保健中促进枪支安全知之甚少。
描述退伍军人对在初级保健就诊期间讨论枪支储存安全（FSS）的看法，并确定初级保健团队与自杀风险较高的退伍军人讨论 FSS 的关键策略。
对来自四个退伍军人焦点小组和六名退伍军人的个人半结构化访谈的记录和笔记进行定性分析。
共有 68 名退伍军人参加。其中三个小组与一个退伍军人健康管理机构有关。小组在年龄、服务时代和性别方面具有多样性。
焦点小组和访谈的目的是评估在初级保健就诊期间接受 FSS 讨论的程度，确定进行 FSS 讨论的促进因素和障碍，并确定初级保健团队有效进行 FSS 讨论的策略。使用扎根理论方法分析转录本和会议记录。
在初级保健中进行 FSS 讨论通常是可以接受的。然而，大多数退伍军人不支持直接询问枪支拥有情况，因为这可能引发对枪支被没收的担忧或限制对枪支的获取。参与者建议初级保健团队提供进行 FSS 讨论的理由，并准备提供有关披露枪支所有权的法律后果的信息。为初级保健工作人员建议的策略还包括采用个性化、关怀和对话的方法，而不是高度脚本化或清单式的方法，以非评判的方式与退伍军人接触，并表达对退伍军人枪支知识的尊重。
在初级保健环境中与退伍军人讨论 FSS 是一种有前途的上游方法，可以补充其他预防自杀的努力，但必须以退伍军人为中心的方式进行。
