We aimed to assess differences in the impact of the COVID-19 public health emergency (PHE) on urban and rural health care facility (HCF) management of intentional overdoses and self-harm using telemedicine consultation from poison control centers (PCCs).
Methods:
We utilized a mixed-methods, explanatory study design of poison centers in the United States. The primary exposures were geography (urban vs. rural HCFs) and time (the pre-COVID-19 PHE [January 1, 2018–March 10, 2020] vs. COVID-19 PHE [March 11, 2020–December 31, 2022]). The primary outcomes were patient disposition: admission to critical care unit (CCU); non-CCU; or psychiatric facility. We measured these associations using a multinomial regression, adjusting for demographic and clinical factors. We interviewed PCC staff to gain insight about perspectives of PCC staff in managing intentional overdoses.
Results:
Of the 1,416,809 intentional overdoses identified, 1,313,704 (93%) were included in our analysis. Compared with urban HCFs in the pre-COVID-19 era, CCU admissions were greater among rural HCFs (adjusted odds ratio [aOR]: 1.12; 95% confidence interval [CI]: 1.10–1.14); however, they were lower in the COVID-19 PHE era within rural (aOR: 0.72; 95% CI: 0.71–0.73) and urban HCFs (aOR: 0.74; 95% CI: 0.73–0.75). Trends were similar in non-CCU and psychiatric admissions. We identified four themes: challenges of admitting overdose cases; changes in calls related to COVID-19 and intentional overdoses; changes in technology, staffing, and operations to adapt to the COVID-19 PHE; and changes in communications for telemedicine.
Conclusions:
The COVID-19 PHE introduced challenges for urban and rural HCFs in treating mental health and overdoses. PCCs are a vital source of telemedicine support available to both urban and rural clinical providers to ease the existing health care burden.
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