Strengthen the Public Health Impact: Local Health Departments Activities to Reduce Emergency Visits for Substance Use Disorders

Importance The Affordable Care Act (ACA) provides substantial financial incentives to prevent Substance Use Disorders (SUDs). Local health departments (LHDs) can receive funds to establish community health teams and foster collaboration with primary care providers and health centers. Yet there remains a gap in our knowledge about how to best integrate LHDs with other health care entities to prevent and improve the treatment of SUDs.

Objective To estimate the effect of LHD activities on emergency visits (EDs) for SUDs using the hospital data of the state of Maryland.

Design We first delineated the role of LHDs in preventing and controlling for SUDs using a conceptual framework from the Centers for Disease Control. We used linked data sets from the Health Cost and Utilization Project (HCUP) Emergency Maryland State Data 2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate the effect of local health departments’ provision of SUD preventive care and SUD-related policy implementation on emergency visits for substance use disorders. We use Geographic Information Systems to examine our data spatially, and multivariate logistic regression to estimate the variation of ED visits for SUDs by LHD activities.

Main Outcomes and Measures 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 visit (OR=0.86, p<0.001). The reduction of ED visit due to LHD prevention efforts is no longer significant (OR=0.94, p=0.17).

Conclusions Results offer insight on the extent to which the LHD activities can affect SUD-related ED visits and provide a foundation for future work to identify effective LHD interventions that can promote integrated behavioral health care and prevent behavioral health disorders. Results are timely to inform the critical role of LHDs in emerging health policy initiatives under the SAMHSA-HRSA Integrated Care Model and the ACA.