Substance Misuse in WNC: Single and Polysubstance Emergency Department Visits
View the data slides here.
Eileen Tallman (WNCHN MPH Spring/ Summer ’22 Intern, Indiana University, Richard M. Fairbanks School of Public Health) and Jo Bradley (WNCHN Data Manager & Improvement Specialist) recently spoke with each other about their work together on a substance misuse data analysis project which involved analysis of single and polysubstance use emergency department (ED) visits in the 18-county region of WNC.
Adrienne Ammerman (WNC Health Network Communications & Improvement Specialist)
Hi, Jo. Hi, Eileen. So, we’re going to get started with our conversation today with just some introductions if you could both tell me who you are, what your role is and a little bit about what you do day to day…
Jo Bradley
I’m Jo Bradley. I’m the Data Manager and Improvement Specialist here at WNC Health Network. And one of my big jobs is collecting and curating the regional data for our 16- to 18-county region. And so that’s what’s going to lead us into Eileen here.
Eileen Tallman
I was a graduate intern with WNC Health Network before I graduated with my Masters of Public Health degree in August. Day-to-day I worked with data, looking at substance misuse in emergency departments in western North Carolina.
Adrienne Ammerman
Eileen, how did you first hear about the Health Network?
Eileen Tallman
I moved to the Asheville area recently and I was looking for ways to get involved in the community, and also meet the requirements for my Capstone project so that I could finish my program, and I found WNC Health Network. I felt it would be a great fit, especially because of the focus on health disparities. And I also really wanted to learn about regional initiatives… In school you talk a lot about national or state or community level health data, but not a lot about regional work. So I thought that was really interesting.
Adrienne Ammerman
Great. We’ve been happy to have you. Let’s talk a little bit about the research that you did.
Eileen Tallman
I knew that I wanted to do something that maybe I could contribute some they were useful information to the region. So in order to do that I needed to learn about racial health priorities. Which Jo can actually talk more about.
Jo Bradley
I’m going to go ahead and share my screen here… And what you should be seeing is a chart of our regional health priorities for the 2021-2023 CHA [Community Health Assessment] cycle. And you’ll notice that many of our counties identified substance misuse, mental health, followed by obesity, healthy eating, active living and nutrition. When we were deciding where we really wanted to start with this project, we went to the [health topic] that was selected by the most counties here in our region, which is substance misuse. So we started there, and then Eileen can tell you a little bit more about how we dug into exactly what we were going to study.
Eileen Tallman
We chose substance misuse, [which is] a very pressing issue. And based on some research that’s already been done, I learned that polysubstance use, or using two or more substances at the same time, is becoming more important, but we really haven’t had the data to study it very well. North Carolina Department of Health and Human Services recently added poly substance misuse as a priority of the state’s opioid and substance abuse action plan. And we had emergency department data. We knew that substance misuse was a driver of emergency department visits, we just didn’t know whether there were differences between people who were using a single substance going to the emergency department, or people who were using two or more substances. So for our analysis, we compared those. We also looked specifically at people who were using opioids, cocaine, or psychostimulants. So psychostimulants are things like methamphetamine. And those were, again, a local priority.
Adrienne Ammerman
And did you have any other partners for this research that you did?
Eileen Tallman
We worked with Dr. Jennifer Runkle, who works at North Carolina State University. She’s an environmental epidemiologist, and she served as a subject matter expert and helped us facilitate that data, provide some technical guidance.
Adrienne Ammerman
Great. So what were some of your high level findings?
Eileen Tallman
What we did find overall, was that substance misuse is increasing in the emergency department for residents of western North Carolina. Overall, we found that between 2016 and 2020 there was a 5% increase across those five years. And we also found, interestingly, that rural residents were coming into the emergency department visit more for poly substance misuse over time. So you can see on the graph that between 2016 and 2019 there was an increase of 5% of people coming in using two or more substances from rural areas. But if you look between 2019 and 2020, interestingly, there’s another 5% increase. We also saw that compared to emergency department visits for opioid and cocaine, psychostimulant-related emergency department visits were on the rise. That’s not a general finding about substance misuse in general in the community. That is the percentage when you compare to opioids and cocaine. And then, overall, we saw that percentages of opioid and psychostimulant emergency department visits nearly doubled for patients reporting as Black or African American who were residents in western North Carolina.
And lastly, we also looked at some other characteristics of the patients coming into the emergency department. So compared to individuals who came in for a single substance, western North Carolina residents coming into the emergency department for poly substance misuse were more than 26 times more likely to have a diagnosis of a mental illness and 76% more likely have been with suicidal ideation or behavior. And we did control for intentional overdoses in that data. They were also two times more likely to have housing or economic problems.
We found some specific differences in individuals coming in using cocaine or psychostimulants. So individuals using cocaine were six times as likely to have a mental illness. And patients coming in for psychostimulant use were more than four times as likely to have a mental illness. They’re also more likely to have housing or economic problems. And this was the group that was most likely to be living in a rural counties.
Basically, we wanted to share what providers can do with data like this, some of this data that’s available. So hospitals and emergency services can use the data to better understand who are coming in to their emergency departments. And we can get important demographic information about the types of individuals who are using specific substances when they come in. Researchers, epidemiologists, and analysts can use data to focus on regional analyses, which is so important. We have a lot of state and national level analyses, but they maybe don’t share insights that are specific to an area. They can also study polysubstance use. Again, this is a topic that more and more people are talking about. But it can help influence funding policy and programs. Substance misuse programs can also make use of data that can help them better understand who are coming into the EDS, so they can better prepare maybe when they make referrals. And informaticists – so those are folks who use data information and knowledge to improve human health and healthcare delivery – they can help make data more accessible so that these groups who may not have the expertise or may not have an easy way to get this data, they can help facilitate.
Adrienne Ammerman
Thank you so much for that high level overview of the research that you did, and how it can be used in our region and for people who are doing this kind of work. Jo, I’m curious how did this project align with the kinds of data projects that we do at the at the Health Network, and our values for how we work with data?
Jo Bradley
Clinical data has long been a data gap for our region, and being able to look at it at the regional level, all the facilities information at one time. And so when we found this opportunity to work with Eileen who’s really interested in hospital data and work with Jen Runkle has been amazing at being in this region, and had access to the data we saw it as a perfect way to kind of dip our toes into the water of clinical data and looking at regional data that way. And we know it’s something that people have been wanting for a long time and have been requesting, and we started with the most important health priority across our region. So that’s just one way that we’re trying to give back to the region.
Adrienne Ammerman
And Eileen, what was your experience like working with the Health Network on this on this research project?
Eileen Tallman
I had a very easy time when I got to work closely with Jo. It was just super responsive and gave me a lot of guidance. So it was a great experience. And, you know, it was a combination of working together and working independently. And I just learned a ton, especially about the region and community health.
Jo Bradley
I think about working with hospital data, there’s a lot of things that I learned as well about what needs to be in place to work with hospitals data and all the analysis.
Adrienne Ammerman
What’s next for you, Eileen?
Eileen Tallman
I’m continuing to dig in a little bit into this data because I was very time limited to get it done for my school project. But we’re continuing to work on that. And also, I’m looking for my next role in public health. So I’m very excited… I just got my degree, so I’m looking for opportunities in community health that will help me make use of my research background and my new skills.
Adrienne Ammerman
Awesome. We can’t wait to see what you end up doing and hope it’s in our region. Jo, I guess on a final note, how can people find out more about WNC Health Network’s data and Data Program?
Jo Bradley
The best place to start is our website [www.wnchn.org]. And we have a specific data section where you can download our full regional data set – that’s our primary and secondary data. That was just updated [in September 2022]. So you’ve got the latest, greatest data there. You can also sign up for our newsletters so that you keep getting information about data releases, we’ve got a lot of really good stuff that’s going to be released over the next year. And then of course, if you’re interested in getting involved or learning more, you can email me at jo.bradley@wnchn.org.
Adrienne Ammerman
Great, thank you so much for sharing about this project and great work.
