Prevalence and Correlates of Firearm Screening and Counseling in Primary Care in Southeast Michigan

The American College of Physicians recommends firearm screening and safety counseling for high-risk patients, although frequency of practice is unclear. The authors evaluated the prevalence and correlates of firearm screening and counseling during health maintenance exams.

The authors performed a cross-sectional analysis of all health maintenance exams for patients aged ≥18 years at an academic center in Southeast Michigan from September 2021 to February 2022. Primary outcomes included documentation of attempted firearm screening and counseling after positive screens. Multinomial logistic regression models estimated the associations between primary outcomes and patient and clinician characteristics using multilevel modeling to account for interclinic variability.

In 27,686 health maintenance exams across 17 clinic sites, attempted screening was documented in 99.8% of visits, principally through routine questionnaires, with positive, negative, or no responses in 15.2%, 48.0%, and 36.8%, respectively. One outlier clinic site documented attempted screening in only 0.9% of health maintenance exams and was excluded. Counseling occurred in 1.1% of positive screens; clinic sites accounted for 36.3% of variability. Counseling was less likely for females (AOR=0.65; 95% CI=0.51, 0.82), patients aged ≥65 years (AOR=0.31; 95% CI=0.21, 0.47), and Asian patients (AOR=0.31; 95% CI=0.16, 0.61) and more likely for internal medicine-pediatrics/family medicine clinicians than internal medicine clinicians (AOR=4.42; 95% CI=1.99, 9.82).

Clinicians documented attempted firearm screening in nearly all health maintenance exams but seldom counseling, which varied across sites and was linked to patient sociodemographic characteristics and clinician specialty as opposed to high-risk clinical features such as psychiatric disorder. Findings suggest that training and quality improvement efforts are needed to ensure appropriate risk-based counseling.