title: Local Health Departments as Clinical Safety Net in Rural Communities.
abstract: The appropriate role of local health departments (LHDs) as a clinical service provider remains a salient issue. This study examines differences in clinical service provision among rural/urban LHDs for early periodic screening, diagnosis, and treatment (EPSDT) and prenatal care services.
  
  
  
  Data collected from the 2013 National Association of County and City Health Officials Profile of Local Health Departments Survey was used to conduct a cross-sectional analysis of rural/urban differences in clinical service provision by LHDs. Profile data were linked with the 2013 Area Health Resource File to derive other county-level measures. Data analysis was conducted in 2015.
  
  
  
  Approximately 35% of LHDs in the analysis provided EPSDT services directly and 26% provided prenatal care. LHDs reporting no others providing these services in the community were four times more likely to report providing EPSDT services directly and six times more likely to provide prenatal care services directly. Rural LHDs were more likely to provide EPSDT (OR=1.46, 95% CI=1.07, 2.00) and prenatal care (OR=2.43, 95% CI=1.70, 3.47) services than urban LHDs. The presence of a Federally Qualified Health Center in the county was associated with reduced clinical service provision by LHDs for EPSDT and prenatal care.
  
  
  
  Findings suggest that many LHDs in rural communities remain a clinical service provider and a critical component of the healthcare safety net. The unique position of rural LHDs should be considered in national policy discussions around the organization and delivery of public health services, particularly as they relate to clinical services.
authors.affiliation: Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee. Electronic address: halenl@etsu.edu.
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Hale
authors.affiliation: Health Policy and Public Health, University of the Sciences, Philadelphia, Pennsylvania.
authors.forename: Tamar
authors.initials: T
authors.lastname: Klaiman
authors.affiliation: Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Beatty
authors.affiliation: Public Health Research Department, NORC at the University of Chicago, Chicago, Illinois.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Meit
mesh_terms: D003430:Cross-Sectional Studies; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D064876:Safety-net Providers; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*