Local Health Department Activities to Reduce Emergency Department Visits for Substance Use Disorders

Abstract

The Affordable Care Act (ACA) provides financial incentives to prevent Substance Use Disorders (SUDs). Local health departments (LHDs) can receive funds to establish care teams that partner with primary care providers and health systems. This study estimates the potential effect of LHDs on emergency visits for SUDs, using linked data sets from the Healthcare Cost and Utilization Project (HCUP) Emergency Department Sample for the State of Maryland-2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate potential effect of local health department's provision of SUD preventive care and SUD-related policy implementation. LHD involvement in SUD-related policy during the past 2 years and provision of preventive care for behavioral health in the past year significantly reduced the probability of having a SUD-related ED visit by 11% and 6%, respectively, after controlling for individual characteristics (OR=0.89, p<0.001; OR=0.93, p<0.001). After adjusting for the individual and contextual factors, LHD involvement in policy was still associated with 14% reduction in SUD-related ED visits (OR=0.86, p<0.001). Results offer insight on the extent to which the LHD activities can possibly affect SUD-related ED visits and provide a foundation for work to identify effective LHD interventions.

Cities as Platforms for Population Health: Past, Present, and Future

“…When local health departments take active roles in mental health prevention, promotion, and coordination, people with mental illness or substance useespecially Black adults and Medicaid enrollees-tend to experience better health outcomes, including fewer substance use-and suicide-related emergency department visits, preventable hospitalizations, and hospital readmissions. [66][67][68][69] Unfortunately, most local health departments do not engage in key mental health activities. 70 The opportunities for collaboration between behavioral health agencies and public health departments are significant, but remain untapped.…”

“…The frequent exclusion of mental health from public health is particularly concerning given evidence that municipal‐level involvement in mental health can have a demonstrable impact. When local health departments take active roles in mental health prevention, promotion, and coordination, people with mental illness or substance use—especially Black adults and Medicaid enrollees—tend to experience better health outcomes, including fewer substance use– and suicide‐related emergency department visits, preventable hospitalizations, and hospital readmissions 66–69 . Unfortunately, most local health departments do not engage in key mental health activities 70 .…”

Perpetrator and situational characteristics associated with security alerts in regional Australian emergency departments

“…Violence in the ED appears to be part of a larger, societal problem with violence and risk-taking behaviour [2,6,9], and public health approaches are thus needed to address the societal component of violence in the ED. Local health department engagement with public health projects has been associated with reduced likelihood of ED presentations involving PSU as well as preventing PSU disorders and reducing violence and crime rates in the community [31].…”

Local Health Departments and the Implementation of Evidence-Based Policies to Address Opioid Overdose Mortality

“…LHDs are vital to community health and their activities are associated with improvements in infectious disease control and chronic disease prevention. 13,[19][20][21] LHDs are also an essential component of the healthcare safety net, particularly in rural areas with few clinical resources. With regard to the opioid overdose crisis, LHDs play a central role as conveners of public, private, and community partners (e.g., first responders, law enforcement, health systems, harm reduction organizations, pharmacists).…”