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Implementation of a Secure Firearm Storage Program in Pediatric Primary Care: A Cluster Randomized Trial.
Rinad S Beidas1, Kristin A Linn2, Jennifer M Boggs3
1Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA Pediatrics
|September 3, 2024
Summary
Implementing an electronic health record (EHR) strategy with clinic support (nudge+) significantly increased the delivery of secure firearm storage programs to children and adolescents compared to EHR documentation templates alone.
Area of Science:
- Public Health
- Pediatrics
- Implementation Science
Background:
- Youth firearm injury and mortality are significant public health concerns in the US.
- Secure firearm storage is a proven preventive measure, yet its implementation in pediatric care is limited.
- Pediatric clinicians often face challenges in routinely delivering evidence-based firearm safety programs.
Purpose of the Study:
- To compare the effectiveness of an electronic health record (EHR) documentation template (nudge) versus nudge plus facilitation (nudge+) in promoting a secure firearm storage program (SAFE Firearm).
- To assess the impact on the delivery of counseling and free cable locks during pediatric well visits.
- To determine if nudge+ significantly increases the reach of the firearm storage program.
Main Methods:
- An unblinded parallel cluster randomized effectiveness-implementation trial (ASPIRE) was conducted across 30 pediatric clinics in the US.
- Clinics were randomized to either the nudge or nudge+ intervention.
- The study analyzed 47,307 well-child visits for children aged 5–17 years, measuring program delivery documented in the EHR.
Main Results:
- The nudge+ intervention resulted in a significantly higher percentage of well-child visits receiving the firearm storage program (49%) compared to the nudge intervention (22%).
- This represents a more than twofold increase in program delivery with the addition of facilitation.
- The difference in reach between nudge+ and nudge was statistically significant.
Conclusions:
- The EHR strategy combined with facilitation (nudge+) is more effective than EHR templates alone in increasing the delivery of evidence-based secure firearm storage programs.
- This finding highlights the importance of integrated support systems for successful implementation of preventive interventions in pediatric settings.
- The results suggest a scalable approach to improve firearm safety counseling and provision of safety devices in routine pediatric care.
