Heywood Case
Member
[My apologies for the excessive length of this post]
From time to time one hears of concerns from doctors asking questions about guns in the home. I just ran across a new report that may be of interest to those who are concerned. The study attempted to identify priorities for "clinical prevention services", that is, what are the most important things medical providers should be addressing with their patients in order to prevent health problems beyond the immediate reasons for the visit. The project involved a 24-member panel headed by former Surgeon General David Satcher, and involved a comprehensive review of more than 8,000 published studies. The goal was to "produce comparable estimates of relative health impact and cost effectiveness for services considered effective by the U.S. Preventative Services Task Force and Advisory Commitee on Immunization Practices" and was an update of a previous study completed in 2001.
The hallmark of the study is that rather than trying to identify all possible things a doctor might ask about, they wanted to identify where they could make the greatest difference, and which would be most cost-effective to implement. Priority scores were assigned that combined "quality adjusted life years" (QALY) and cost effectiveness (QALY divided by estimated costs). I won't make this even longer by going into lots of details on the methods; that is available at the link referenced below.
In the 2001 report, firearms were included in a single grouped category in the 30 that rose to the top: "Assess the safety practices of all persons aged >= 4 and provide counseling on: seatbelt use, smoke detector use, firearm storage / removal from home, bicycle / motorcycle helmet use, dangers of alcohol use, protection against slip and fall hazards for older persons." This item was ranked 27th on the list, with a priority score of 3 (scores ranged from 2 to 10). The top three items included vaccination of children, screening and counseling for tobacco use, and screening for vision impairment among adults 65 and older (scores 10, 9, and 9). So even when included with a host of other factors, firearms in the home ranked very low on the list.
Now looking at the 2006 report, the first thing that jumped out at me was that firearms are not even mentioned. There is a single category for "injury prevention counseling", which now includes "child safety seats, window / stair guards, pool fence, poison control, hot water temperature, and bicycle helmets" and is referenced for "parents of children aged < 5 years". This category was 20th of a list of 25 priority areas, with a priority score of 4 (again scores ranged from 2 to 10). At the top of the list was discussion of aspirin use for prevention of hear attacks, childhood immunization, and smoking.
In summary, the presence of firearms in the home is not listed as a priority at all, and even injury prevention framed globally came out quite low on the list of "bang for the buck" priorities for clinical screening and intervention by doctors.
Of course, this doesn't mean the public health community has decided that firearms in the home are a wonderful thing. The authors make a point of saying that there are many areas where there is insufficient research for estimates within the study framework, and that issues with smaller "target populations" ranked low by definition even though they may be important under some conditions (my words). But firearms aren't mentioned in this context either.
One might also quibble with the overall methodology, the philosophy of how the researchers defined the priorities or the value of the very notion of "clinical preventive services." I'm not going to concern myself there. In the authors' concluding words, "The goal of this study was to summarize the best available data on clinical preventive services to assist all types of decision makers in choosing where to focus their prevention efforts." They did their best, and at the end of the day there were a lot more important things for them to worry about than firearms in the home.
And you can bet that if they could have found a reason to include firearms in the list, they would have...
Maciosek et. al. (2006). Priorities Among Effective Clinical Preventive Services: Results of a Systematic Review and Analysis. American Journal of Preventive Medicine (in press). Full text and supporting documents available at http://www.prevent.org/content/view/46/96/.
From time to time one hears of concerns from doctors asking questions about guns in the home. I just ran across a new report that may be of interest to those who are concerned. The study attempted to identify priorities for "clinical prevention services", that is, what are the most important things medical providers should be addressing with their patients in order to prevent health problems beyond the immediate reasons for the visit. The project involved a 24-member panel headed by former Surgeon General David Satcher, and involved a comprehensive review of more than 8,000 published studies. The goal was to "produce comparable estimates of relative health impact and cost effectiveness for services considered effective by the U.S. Preventative Services Task Force and Advisory Commitee on Immunization Practices" and was an update of a previous study completed in 2001.
The hallmark of the study is that rather than trying to identify all possible things a doctor might ask about, they wanted to identify where they could make the greatest difference, and which would be most cost-effective to implement. Priority scores were assigned that combined "quality adjusted life years" (QALY) and cost effectiveness (QALY divided by estimated costs). I won't make this even longer by going into lots of details on the methods; that is available at the link referenced below.
In the 2001 report, firearms were included in a single grouped category in the 30 that rose to the top: "Assess the safety practices of all persons aged >= 4 and provide counseling on: seatbelt use, smoke detector use, firearm storage / removal from home, bicycle / motorcycle helmet use, dangers of alcohol use, protection against slip and fall hazards for older persons." This item was ranked 27th on the list, with a priority score of 3 (scores ranged from 2 to 10). The top three items included vaccination of children, screening and counseling for tobacco use, and screening for vision impairment among adults 65 and older (scores 10, 9, and 9). So even when included with a host of other factors, firearms in the home ranked very low on the list.
Now looking at the 2006 report, the first thing that jumped out at me was that firearms are not even mentioned. There is a single category for "injury prevention counseling", which now includes "child safety seats, window / stair guards, pool fence, poison control, hot water temperature, and bicycle helmets" and is referenced for "parents of children aged < 5 years". This category was 20th of a list of 25 priority areas, with a priority score of 4 (again scores ranged from 2 to 10). At the top of the list was discussion of aspirin use for prevention of hear attacks, childhood immunization, and smoking.
In summary, the presence of firearms in the home is not listed as a priority at all, and even injury prevention framed globally came out quite low on the list of "bang for the buck" priorities for clinical screening and intervention by doctors.
Of course, this doesn't mean the public health community has decided that firearms in the home are a wonderful thing. The authors make a point of saying that there are many areas where there is insufficient research for estimates within the study framework, and that issues with smaller "target populations" ranked low by definition even though they may be important under some conditions (my words). But firearms aren't mentioned in this context either.
One might also quibble with the overall methodology, the philosophy of how the researchers defined the priorities or the value of the very notion of "clinical preventive services." I'm not going to concern myself there. In the authors' concluding words, "The goal of this study was to summarize the best available data on clinical preventive services to assist all types of decision makers in choosing where to focus their prevention efforts." They did their best, and at the end of the day there were a lot more important things for them to worry about than firearms in the home.
And you can bet that if they could have found a reason to include firearms in the list, they would have...
Maciosek et. al. (2006). Priorities Among Effective Clinical Preventive Services: Results of a Systematic Review and Analysis. American Journal of Preventive Medicine (in press). Full text and supporting documents available at http://www.prevent.org/content/view/46/96/.
Commence hysterics.
