Evaluating Poison Control Center Telemedicine Support for Health Care Facilities in Managing Overdose and Suicide During COVID-19.

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). 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. 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. 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.