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2023 HSR&D/QUERI National Conference Abstract

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4062 — Quantitative and qualitative perspectives on firearm injuries among U.S. Veterans

Lead/Presenter: Kathleen Carlson,  COIN - Portland
All Authors: Bhakta Y (Portland VA Health Care System, Center to Improve Veteran Involvement in Care (CIVIC)), , Maxim L (Portland VA Health Care System, Center to Improve Veteran Involvement in Care (CIVIC)), Krushnic D (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)), Goheen C (Portland VA Health Care System, Center to Improve Veteran Involvement in Care (CIVIC)), Hooker E (Portland VA Health Care System, Center to Improve Veteran Involvement in Care (CIVIC)), Gilbert T (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))

Objectives:
Patterns of firearm injuries among Veterans and differences in firearm injury trends by individual Veteran characteristics are not well understood. To better understand opportunities to address firearm injury prevention from within the VA healthcare setting, this study examined injury patterns and healthcare treatment among a national sample of Veteran VA users treated for firearm injury. A complementary qualitative study examined perspectives of Veterans who experienced a firearm injury.

Methods:
A national random sample of Veterans with firearm injury-related visits to a VA facility between January 1st, 2010 and December 31st, 2019 was identified using VA administrative data. Comprehensive chart reviews were conducted to extract Veteran demographics, injury circumstances, and healthcare treatment data; frequencies of these characteristics were examined. Qualitative methods for the Database of Individual Patient Experiences (DIPEx) were used to interview Veterans with prior firearm injury experience. Their perspectives on firearms, firearm injuries, and firearm safety-related interactions with the healthcare system were recorded and transcribed; transcripts were analyzed using thematic analysis.

Results:
From chart reviews, a majority of injuries were nonfatal (90.1%). About half (45.7%) were unintentional injuries, while 24.1% were related to assault/homicide and 17.6% were self-directed/suicide. The patient was the shooter for 61.8% of injuries. Most injuries (81.9%) were first treated at a local emergency department. The VA healthcare system provided follow up treatment for 63.8% of injuries. Over half (62.3%) of injuries occurred among Veterans with at least one mental health condition at the time of the injury. Documentation of a firearm injury prevention intervention was not common for these patients (7.2%). During DIPEx interviews, patients described their diverse firearm injury experiences and consequences. These audio and video clips or written transcripts of Veterans’ experiences can be used to increase healthcare providers’ understanding of and approaches to prevention of firearm injuries.

Implications:
Large proportions of firearm injuries among Veterans were nonfatal and unintentional; however, most led to multiple healthcare visits. Documentation of firearm injury prevention interventions in these Veterans’ healthcare records was rare, meaning there are considerable missed opportunities for firearm injury prevention in VA healthcare settings.

Impacts:
Increased firearm injury prevention efforts are needed in the VA healthcare system to reduce firearm injuries and deaths among Veterans nationally. Using both quantitative and qualitative data allows for a more robust understanding of Veterans’ experiences with firearm injuries and interactions with the healthcare system. This work will advance understanding of firearm injuries and can be used to support efforts to increase firearm safety-related interventions from within the VA healthcare system.