UNIVERSAL SCREENING FOR FIREARM INJURY RISK COULD REDUCE HEALTHCARE'S HESISTANCY IN TALKING TO PATIENTS ABOUT FIREARM SAFETY.
UNIVERSAL SCREENING FOR FIREARM INJURY RISK COULD REDUCE HEALTHCARE'S HESISTANCY IN TALKING TO PATIENTS ABOUT FIREARM SAFETY.
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对枪伤风险进行全面筛查可以减少医疗保健部门在与患者谈论枪械安全问题时的犹豫不决。
DOI：
10.1097/as9.0000000000000121
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Kapoor,Sandeep
中科院分区：
文献类型：
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作者：
Sathya,Chethan;Kapoor,Sandeep
尽管长期以来医疗保健行业一直支持公共卫生方法来预防枪支伤害和死亡，但少数医生，外科医生，护士和社会工作者向患者询问有关枪支使用或枪支暴力风险的问题，更不用说关于枪支安全的咨询了。1，2对于我们大多数人来说，与火器伤害预防相关的筛查和咨询，虽然被证明是有益的，3继续落在“常规护理”的保护伞之外，并且通常保留给被认为是“高风险”的患者，例如那些有自杀倾向的患者，攻击相关的伤害，或感知风险。1-3但是，对于我们来说，实践我们所宣扬的，一个完整的重新思考使用一种新颖的，非传统的，非歧视性的通用火器伤害风险筛查方法，跨越创伤，紧急情况和初级保健设置，为所有患者，无论访问的原因，可能是改变范式所需的变革。通过询问每一个病人关于火器伤害风险的问题，作为常规手术或医疗护理的一部分，我们最终可能能够打破障碍，并与病人谈论火器安全。毕竟，对于任何公共卫生问题，这一切都始于监测和筛查。如果我们不能从一开始就放心地提出必要的问题，那么在我们国家的火器伤害和暴力公共卫生危机的医疗保健方面取得的全面进展将继续难以实现。在处理艾滋病毒、烟草使用和药物使用等其他两极分化的公共卫生问题时，已成功地采用了“我们问每个人”的办法，4这表明，这种办法可能有益于使关于枪支安全的对话正常化和人性化。一种通用的方法可以有效地消除临床团队成员是否进行筛查的决定点，从而避免基于风险感知的污名化，判断和不必要的患者分析。[4]可以想象，从医护人员和患者的角度来看，这可以显著增加对这个话题的舒适度。几乎所有的卫生保健提供者，包括那些在创伤，急诊，老年，儿科和初级保健设置，是唯一准备将这些问题纳入现有的常规伤害预防指南。那么，为什么不考虑同样的方法来预防火器伤害呢？无可否认，有针对性地筛查火器伤害风险比通用方法更可行，特别是考虑到医护人员已经有许多风险因素筛查问题要问。1，2许多人会争辩说，如果我们问每个人关于枪支安全的问题，我们可能会给临床工作人员带来负担，这些问题可能不会产生大量的“积极”屏幕。然而，火器伤害和死亡仍然是美国可预防死亡的主要原因之一。根据疾病控制中心最近的一份报告，2018年有39，000名美国人死于火器伤害，更不用说无数其他因非致命火器伤害而遭受创伤和发病的人了。枪支暴力简直是地方性的，仅其普遍存在就要求我们创造性地利用一切可用资源来解决这一公共卫生问题。1因此，在有火器伤害风险的人中实施一种普遍的筛查和干预方法当然是必要的，也是早就应该的，这将使我们能够同时进行研究，以确定障碍，并确定什么可行，什么不可行。由于几十年来研究资金有限，对火器伤害预防策略的研究很少，我们不能忽视这样一个事实，即火器伤害在许多方面类似于一种新的疾病。我们...
Despite vast long-standing healthcare industry support for a public health approach to firearm injury and mortality prevention—still—the minority of physicians, surgeons, nurses, and social workers ask patients questions about firearm access or gun violence risk, let alone counsel about firearm safety. 1, 2 For most of us, screening and counseling related to firearm injury prevention, although demonstrated to be beneficial, 3 continues to fall outside the umbrella of “usual care” and is often reserved for patients deemed “high risk” such as those presenting with suicidality, assault-related injuries, or perceived risk. 1–3 But for us to practice what we preach, a complete rethink using a novel, unconventional, and nondiscriminatory universal firearm injury risk screening approach across trauma, emergency, and primary care settings—for all patients regardless of reason for visit—may be the transformative change needed to shift the paradigm. By asking each and every patient questions about firearm injury risk as part of routine surgical or medical care, we may finally be able to break down barriers and get comfortable talking to patients about firearm safety. After all, for any public health issue, it all starts with surveillance and screening. If we cannot get comfortable asking the necessary questions in the first place, holistic progress from the healthcare lane on our nation’s public health crisis of firearm injury and violence will continue to prove elusive. A “we ask everyone” approach has been used successfully in dealing with other polarized public health issues, such as HIV, tobacco use, and substance use, 4 suggesting that it could be beneficial in normalizing and humanizing conversations about firearm safety. A universal approach can effectively remove the decision point for clinical team members of whether to screen or not, thereby avoiding stigmatization, judgment, and unnecessary profiling of patients based on risk perception. 4 As one can imagine, this could significantly increase comfort with this topic from both the healthcare worker and patient perspective. And virtually all health care providers, including those in trauma, emergency, geriatric, pediatric, and primary care settings, are uniquely poised to integrate these questions into existing routine injury prevention guidance. So why not consider the same approach for firearm injury prevention? Undeniably, targeted screening for firearm injury risk is far more feasible than a universal approach, especially considering that healthcare workers already have numerous risk factor screening questions to ask. 1, 2 Many would argue that if we ask everyone about firearm safety, we could overburden clinical staff with questions that may not yield a significant number of “positive” screens. Yet firearm injury and mortality remains one of the leading causes of preventable death in the United States. 1 According to a recent Centers for Disease Control report, 39,000 Americans died from firearm injury in 2018, let alone countless others who suffered trauma and morbidity from nonfatal firearm injuries. Gun violence is nothing short of endemic and its prevalence alone demands that we creatively use all resources available to address this public health issue. 1 Hence, implementing a universal approach to screening and intervening among those at risk of firearm injury is certainly warranted and overdue, and will allow us to perform research in parallel to identify barriers and determine what works and what does not. Due to the paucity of research on firearm injury preventative strategies, resulting from decades of limited research funding, we must not lose sight of the fact that in many ways firearm injury is akin to a new disease. We …