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2023 HSR&D/QUERI National Conference Abstract

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1128 — Emerging Strategies to Incorporate Firearm Injury Prevention into VA Healthcare: Results of Qualitative Interviews with Providers and Patients

Lead/Presenter: Lauren Maxim,  Portland VA Health Care System, Center to Improve Veteran Involvement in Care (CIVIC)
All Authors: Maxim L (Portland VA Health Care System, Center to Improve Veteran Involvement in Care (CIVIC)), Lafferty, M (Portland VA Health Care System, Center to Improve Veteran Involvement in Care (CIVIC)) DeFrancesco, S (Portland VA Health Care System, Center to Improve Veteran Involvement in Care (CIVIC) and Oregon Health and Science University – Portland State University School of Public Health) Bhakta, Y (Portland VA Health Care System, Center to Improve Veteran Involvement in Care (CIVIC)) Carlson, K (Portland VA Health Care System, Center to Improve Veteran Involvement in Care (CIVIC) and Oregon Health and Science University – Portland State University School of Public Health)

Objectives:
Population-level prevention of firearm injuries and death is essential. Firearm owners vary widely in their reasons for and behaviors around firearm ownership, use, and storage. To be effective, prevention efforts must be informed by the impacted communities’ perspectives. Among Veterans, injuries and suicides from firearms occur at a higher rate compared to non-Veterans. VA healthcare environments offer unique opportunities to prevent firearm injuries and reduce risk of firearm suicide. Based on input from VA providers and from Veterans who own firearms, this study identified emerging strategies for a comprehensive, VA healthcare-based firearm injury prevention program.

Methods:
We identified VA healthcare facilities nationally that treated a relatively high rate of patients with firearm-related injuries between 2010 and 2019. Next, we determined the proportion of rural-residing Veterans served at these facilities. We identified Veterans with a recent VA healthcare visit to several of these rural facilities and an urban facility, and mailed recruitment letters. Veterans were eligible to participate in interviews if they owned, recently owned, or lived with someone who owned a firearm. Professional contacts at each VA facility suggested providers who then received a recruitment email to participate in individual interviews. Forty Veterans and 20 VA providers participated. Interviews were audio-recorded, transcribed, and analyzed using rapid analysis.

Results:
Initial Veteran interviews generated ideas that were then incorporated into subsequent Veteran and provider interviews to elicit reactions and additional suggestions. Emerging ideas endorsed by both patients and providers revolved around: 1) provision of firearm safe storage devices in real time and at reduced cost; 2) identification of “credible messengers” to develop and disseminate firearm injury prevention messaging; 3) environmental changes that normalize education and discussion about firearm safety; and 4) incorporation of social opportunities with firearm safety training.

Implications:
Firearm injury prevention strategies are more likely to be effective when informed by the communities experiencing those injuries and deaths. Providers and Veterans generated multiple recommendations about potentially effective prevention strategies within the VA healthcare environment.

Impacts:
The VA healthcare environment offers unexplored opportunities to prevent firearm injuries and deaths among all firearm owners. Talking with providers and with patients who own firearms led to identification of emerging strategies. These strategies will be incorporated into development of a comprehensive firearm injury prevention program within VA healthcare.