Sharp spike in behavioral health cases at Mass. emergency rooms
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Emergency rooms, such as those at Saint Vincent Hospital in Worcester, have seen a spike in behavioral health cases in the last year.
Total emergency room use in Massachusetts dropped slightly in 2014, but visits associated with a behavioral health conditions rose sharply, according to preliminary Health Policy Commission findings.
Early data from the commission's 2015 Cost Trends Report show a nearly 24 percent statewide increase in behavioral health-related emergency department visits from 2010 to 2014. A visit is classified as behavioral health-related if it involves mental health or substance use disorders.
During the same time period, avoidable emergency room visits fell by 3.5 percent and the overall number of emergency room visits declined by less than half of a percent.
Behavioral health-related emergency department visits grew more sharply in some parts of the state, including a 53 percent jump in Fall River and a 48 percent increase in New Bedford over the past five years. During the same time period, the eastern portion of the Merrimack Valley saw a 40 percent increase, and the region comprised of the western Merrimack Valley plus Middlesex County had a 41 percent increase.
The Berkshires are only part of the state where the rate of behavioral health visits has dropped since 2010, with a 4 percent decline, the report says.
Seven percent of emergency room visits in 2014 were for behavioral health conditions, 38 percent were for emergency purposes, and 42 percent were classified as avoidable because they either were for a non-emergent condition or were treatable by a primary care provider. Five percent were considered "preventable" emergency visits, and 7 percent of visits were unclassified.
The commission found that access to a retail clinic or urgent care center -- both of which are often open beyond normal business hours -- is associated with lower use of hospital emergency rooms. In areas with a retail clinic or urgent care center nearby, there were 30 percent fewer emergency department visits compared to areas where there was no easily accessible alternative site, the report said.
Poor access to after-hours care contributed to a high share of emergency department visits in the past 12 months, according to the report. Sixty percent of recent emergency room patients were unable to get an appointment at a doctor's office or clinic as soon as they needed one, and 76 percent of recent visits were for care after normal operating hours of doctor's offices and clinics.
Retail clinics, located in pharmacies or stores and typically staffed by nurse practitioners, and urgent care centers, which are most often free-standing physicians' offices with extended hours, have expanded dramatically in Massachusetts since 2008, the report found. As of this year, there are 84 urgent care facilities in the state, up from 10 in 2008. The number of retail clinics has grown from 11 to 58.
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