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Synthesizing 30-years of adult medicaid dental policy research: A scoping review to identify gaps and opportunities. Heliyon 2023; 9:e13703. [PMID: 36873142 PMCID: PMC9975108 DOI: 10.1016/j.heliyon.2023.e13703] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
Objective Despite the importance of Medicaid for the oral health of low-income adults, the extent to which Medicaid dental policy variation influences outcomes is unknown. This study aims to review the evidence evaluating adult Medicaid dental policies to synthesize conclusions and motivate future research. Data sources A comprehensive search of academic literature published in English between 1991 and 2020 was conducted to identify studies which evaluated an adult Medicaid dental policy for its effect on outcomes. Studies strictly involving children, policies not related to adult Medicaid dental coverage, and non-evaluation studies were excluded. The data analysis identified the policies, outcomes, methods, populations, and conclusions of the included studies. Results Among the 2731 unique articles extracted, 53 met the inclusion criteria. 36 studies evaluated the effect of expanding Medicaid dental coverage, which was found to consistently increase dental service visits (21 studies) and reduce unmet dental needs (4 studies). Provider density, reimbursement rates, and level of benefits appear to influence the effect of expanding Medicaid dental coverage. The evidence for changing Medicaid benefits and reimbursement rates were mixed for its impact on provider participation and emergency dental services. Few studies examined how adult Medicaid dental policies impact health outcomes. Conclusions Most of the recent research has focused on evaluating the effect of expanding or reducing Medicaid dental coverage on dental service utilization. Future research investigating the impact of adult Medicaid dental policies on clinical, health, and wellness outcomes remains warranted. Clinical significance Low-income adults are responsive to Medicaid dental policy changes and utilize more care with more generous coverage. Less is known about how these policies influence health.
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Frichembruder K, Prass TS, Hugo FN. [Times series of dental emergency attendance in Brazil between 2008 and 2015]. CIENCIA & SAUDE COLETIVA 2022; 27:3215-3226. [PMID: 35894332 DOI: 10.1590/1413-81232022278.22302021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/06/2022] [Indexed: 11/22/2022] Open
Abstract
The option to use emergency dental services is dependent upon the social, epidemiological and organizational conditions of the health services. In order to evaluate the specific emergency indicators in the care network for understanding access and performance, a time series study of emergency dental care according to the codes of care by health facilities in Brazil from 2008 to 2015 was carried out. Health services were grouped into primary and secondary care points and total services. Secondary services were subdivided into specialized and hospital services. The primary care group accounted for 72.75% of the emergency care and the mean of the standardized rate of total emergencies was 0.04 visits per inhabitant. The trend for total services was stable, though there was growth in primary health care services (5.58%/year). The results highlight the participation of primary health care services in the care of dental emergencies, followed by specialized and hospital services, which is in line with the assumption of the inverse relationship between the capacity of emergency dental care service and its technological density.
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Affiliation(s)
- Karla Frichembruder
- Centro de Pesquisas em Odontologia social, Universidade Federal do Rio Grande do Sul (UFRGS). R. Ramiro Barcelos 2492, sala 402, Santa Cecília. 90035-003 Porto Alegre RS Brasil.
| | - Taiane Schaedler Prass
- Programa de Pós-Graduação em Estatística, Instituto de Matemática e Estatística, UFRGS. Porto Alegre RS Brasil
| | - Fernando Neves Hugo
- Programa de Pós-Graduação em Odontologia, Faculdade de Odontologia, UFRGS. Porto Alegre RS Brasil
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3
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Analysis of adult dental emergencies at a medical center in southern Taiwan. J Dent Sci 2022; 17:1314-1320. [PMID: 35784161 PMCID: PMC9236923 DOI: 10.1016/j.jds.2022.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background/purpose Materials and methods Results Conclusion
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4
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The Effects of Dexamethasone on the Time to Pain Resolution in Dental Periapical Abscess. J Emerg Med 2021; 60:506-511. [PMID: 33483197 DOI: 10.1016/j.jemermed.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Dental infections are frequently encountered in the emergency department (ED), with periapical abscesses being among the most painful. Traditional pain management strategies include local anesthetic injections, oral analgesics, and intravenous opioids. OBJECTIVES We sought to identify an alternative pain management strategy with early use of dexamethasone as adjunct to conventional therapies for inflammation and pain at the site of infection. METHODS We conducted a prospective, randomized, double-blind, placebo-controlled study comparing the analgesic effect of dexamethasone and placebo in ED patients with periapical abscess during a 2-year timeframe at two urban academic EDs. Adult patients presenting with physical examination findings consistent with a diagnosis of periapical abscess were randomized to receive oral dexamethasone or an identical placebo. Pain was assessed using the verbal numeric scale in person at discharge and via telephone at 12, 24, 48, and 72 h after discharge from the ED. RESULTS Seventy-three patients were enrolled, with 37 receiving dexamethasone and 36 receiving placebo. Follow-up pain scores were obtained for 52 patients at 12, 24, 48, and 72 h. Ten patients from the dexamethasone group and 11 from placebo group were lost to follow-up. Patients who received dexamethasone reported a greater reduction in pain at 12 h compared with the placebo group (p = 0.029). Changes in pain scores from baseline and at 24, 48, and 72 h were not statistically significant. No adverse events were reported. CONCLUSIONS Single-dose dexamethasone as adjunct to conventional medical management for pain caused by periapical abscess demonstrated a significant reduction in pain 12 h post treatment compared with placebo.
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Azadani EN, Townsend J, Peng J, Wheeler K, Xiang H. The association between traumatic dental and brain injuries in American children. Dent Traumatol 2020; 37:114-122. [PMID: 33128842 DOI: 10.1111/edt.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM It is crucial that dentists who treat traumatic dental injuries rule out concomitant brain injuries. Despite anatomic proximity, controversy exists regarding association between facial trauma and head injury. The aim of this study was to examine the association between dento-alveolar trauma (DAT) and traumatic brain injuries (TBI) using a national dataset of emergency department (ED) visits. MATERIAL AND METHODS Nationwide Emergency Department Sample (NEDS) data, one of the Healthcare Cost and Utilization Project (HCUP) datasets, were analyzed. Encounters of patients age 0-18 years with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes associated with DAT and TBI in the 2010-2014 NEDS were identified. Data were analyzed using descriptive statistics, chi-square test, and logistic regression models to investigate the association between DAT and TBI and factors associated with TBI in DAT-positive patients. RESULTS During the study period, 6 281 658 ED visits were associated with traumatic injuries. DAT was recorded in 93 408 (1.5%) and TBI was recorded in 996 334 (15.9%) of these traumatic injury visits. Within the group of DAT-positive encounters, 7035 (7.5%) had codes associated with TBI. Of trauma encounters where a DAT was not involved (6 188 250 encounters), 989 299 (16%) had an associated TBI code. Patients with DAT had 0.20 odds of having TBI (95% CI, 0.19-0.20, P < .0001) compared with patients who did not have DAT when all other confounding variables were kept constant. Having multiple injuries, being involved in motor vehicle crashes, and injuries due to assault were associated with higher odds of concomitant TBI in patients who sustained DAT. CONCLUSIONS There was an inverse association between DAT and TBI in this study population.
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Affiliation(s)
- Ehsan N Azadani
- Department of Dentistry, Nationwide Children's Hospital and Division of Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus, OH, USA
| | - Janice Townsend
- Department of Dentistry, Nationwide Children's Hospital and Division of Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus, OH, USA
| | - Jin Peng
- Research Information Solutions and Innovation Research & Development, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Krista Wheeler
- Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.,Center for Pediatric Trauma Research and Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Henry Xiang
- Center for Pediatric Trauma Research and Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital and Division of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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Lee HH, Faundez L, Nasseh K, LoSasso AT. Does Preventive Care Reduce Severe Pediatric Dental Caries? Prev Chronic Dis 2020; 17:E136. [PMID: 33119483 PMCID: PMC7665577 DOI: 10.5888/pcd17.200003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Tertiary oral health services (caries-related surgery, sedation, and emergency department visits) represent high-cost and ineffective ways to improve a child's oral health. We measured the impact of increased Texas Medicaid reimbursements for preventive dental care on use of tertiary oral health services. METHODS We used difference-in-differences models to compare the effect of a policy change among children (≤9 y) enrolled in Medicaid in Texas and Florida. Linear regression models estimated 4 outcomes: preventive care dental visit, dental sedation, emergency department use, and surgical event. RESULTS Increased preventive care visits led to increased sedation visits (1.7 percentage points, P < .001) and decreased emergency department visits (0.3 percentage points, P < .001) for children aged 9 years or younger. We saw no significant change in dental surgical rates associated with increased preventive dental care reimbursements. CONCLUSION Increased access to preventive dentistry was not associated with improved long-term oral health of Medicaid-enrolled children. Policies that aim to improve the oral health of children may increase the effectiveness of preventive dentistry by also targeting other social determinants of oral health.
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Affiliation(s)
- Helen H Lee
- Department of Anesthesiology, College of Medicine, University of Illinois at Chicago, 1740 W Taylor St, Ste 3200W, MC 515, Chicago, IL 60612.
| | - Luis Faundez
- Department of Economics, University of Illinois at Chicago, Chicago, Illinois
| | - Kamyar Nasseh
- Health Policy Institute, American Dental Association, Chicago, Illinois
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Akinlotan MA, Ferdinand AO. Emergency department visits for nontraumatic dental conditions: a systematic literature review. J Public Health Dent 2020; 80:313-326. [DOI: 10.1111/jphd.12386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/24/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Marvellous A. Akinlotan
- Department of Health Policy and Management Texas A&M School of Public Health College Station TX USA
| | - Alva O. Ferdinand
- Department of Health Policy and Management Texas A&M School of Public Health College Station TX USA
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Ranade A, Young G, Garcia R, Griffith J, Singhal A, McGuire J. Changes in Dental Benefits and Use of Emergency Departments for Nontraumatic Dental Conditions in Massachusetts. Public Health Rep 2020; 135:571-577. [PMID: 32795220 DOI: 10.1177/0033354920946788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Research examining the effect of changes in Medicaid dental benefits on emergency department (ED) use for dental conditions has had mixed results. We examined the effect of changes in Medicaid dental benefits on ED use for nontraumatic dental conditions (NTDCs) among adults in Massachusetts before and after Medicaid dental benefits for adults were eliminated (July 2010) and partially restored (January 2013). METHODS We used 2009-2013 data from the Massachusetts All-Payer Claims Database. The study population included Medicaid enrollees aged ≥21 who made a visit to the ED for an NTDC that was paid for by Medicaid during the study period. We used an interrupted time-series study design and segmented regression model to assess the effect of the policy changes on ED use for NTDCs. We also conducted a subanalysis by patient age, sex, and geographic location. RESULTS During the study period, 21 731 Medicaid enrollees aged ≥21 made 35 660 NTDC ED visits. Eliminating comprehensive dental benefits led to a significant increase in the use of EDs for NTDCs. This increase occurred over time (11% increase at 15 months after elimination of comprehensive dental benefits; estimate, 0.64 [95% CI, 0.07-1.21]; P = .03) rather than immediately after the policy change took effect. The partial restoration of certain dental benefits led to a significant decrease in the rate of ED visits for NTDCs over time (15.7% decrease at 5 months after partial restoration of certain dental benefits; estimate, -0.97 [95% CI, -1.83 to -0.11]; P = .03). CONCLUSION Strengthening dental coverage policies for adult Medicaid enrollees could decrease their reliance on EDs for NTDCs.
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Affiliation(s)
- Ashwini Ranade
- 1848 Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.,1825 Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
| | - Gary Young
- 1848 Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.,1848 D'Amore-McKim School of Business, Northeastern University, Boston, MA, USA.,1848 Center for Health Policy and Healthcare Research, Northeastern University, Boston, MA, USA
| | - Raul Garcia
- 1846 Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - John Griffith
- 1848 Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Astha Singhal
- 1846 Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - Jean McGuire
- 1848 Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
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9
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Bilder L, Horwitz J, Zigdon-Giladi H, Gutmacher Z. Emergency department visits at Rambam health care campus, Israel: non-trauma related dental conditions. Isr J Health Policy Res 2020; 9:26. [PMID: 32443973 PMCID: PMC7243313 DOI: 10.1186/s13584-020-00385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/06/2020] [Indexed: 11/12/2022] Open
Abstract
Objectives Studies of emergency department (ED) visits for non-traumatic dental conditions (NTDCs) have been carried out in the USA and Canada. In Israel, there is a shortage of such studies. In the current retrospective study, we report on the frequency and distribution of NTDCs ED visits at Rambam Health Care Campus (Rambam), in Haifa, which is an academic hospital serving more than 2.4 million residents of Northern Israel. Materials and methods The data concerning ED visits at Rambam between 2010 and 2017 were obtained retrospectively from Rambam’s computerized clinical and personal database of adult patients (≥18 years) visiting the ED for NTDCs. Results Overall, 1.8% of the patients who visited the Rambam ED, were identified as presenting with NTDCs. From 2010 until 2017, the number of NTDCs admissions increased by 45%, while the total ED admissions rose by 16%. The average waiting time for maxillofacial consultations for patients with NTDCs increased from 102 min in 2010 to 138 min in 2017. The busiest hours in the ED for NTDCs were during the morning shifts (47% of daily visits). Conclusions The results of the study show that systemic and conceptual changes are needed to reduce the number of non-trauma related applications to ED.These changes can be by increasing the number of personnel or by introducing recent advances such as tele-medicine for prescreening of patients. This change calls for a greater involvement of the health policy leaders to provide alternative solutions for emergency dental care.
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Affiliation(s)
- Leon Bilder
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel.
| | - Jacob Horwitz
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel
| | - Hadar Zigdon-Giladi
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel
| | - Zvi Gutmacher
- Department of Maxillofacial Rehabilitation and Temporomandibular Disorders Unit, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel
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10
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Poudel P, Griffiths R, Wong VW, Arora A, Flack JR, Khoo CL, George A. Perceptions and practices of general practitioners on providing oral health care to people with diabetes - a qualitative study. BMC FAMILY PRACTICE 2020; 21:34. [PMID: 32054440 PMCID: PMC7020546 DOI: 10.1186/s12875-020-1102-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
Abstract
Background Poorly controlled diabetes leads to multiple complications including oral health problems. General practitioners (GPs) are at the forefront of management of chronic diseases in primary health care. Diabetes guidelines encourage a proactive role for GPs in oral health complications management in people with diabetes, yet little is known about this area of care. This study aimed to explore current practices, perceptions and barriers of GPs towards oral health care for people with diabetes. Methods We employed a qualitative research method utilising telephone interviews. Purposive and snowball sampling were used to recruit 12 GPs from Greater Sydney region. A thematic analysis involving an inductive approach was used to identify and analyse contextual patterns and themes. Results A majority of participants were males (n = 10), working in group practices (n = 11) with a mean ± SD age of 55 ± 11.4 years and 25 ± 13.6 years work experience. Three major themes emerged: oral health care practices in general practice settings; barriers and enablers to oral health care; and role of diabetes care providers in promoting oral health. Most GPs acknowledged the importance of oral health care for people with diabetes, identifying their compromised immune capacity and greater risks of infections as risk factors. GPs reported 20–30% of their patients having oral health problems, however their current oral health care practices relating to education, risk assessment and referrals were reported as very limited. GPs identified several barriers including time constraints, absence of referral pathways, and limited knowledge and training in promoting oral health care. They also reported patient barriers including oral health care costs and lower oral health awareness. GPs perceived that resources such as education/training, a standardised assessment tool and patient education materials could support them in promoting oral health care. GPs also perceived that other diabetes care providers such as diabetes educators could play an important role in promoting oral health. Conclusions Despite current recommendations, GPs’ current oral health care practices among people with diabetes are limited. Further strategies including capacity building GPs by developing appropriate oral health training programs and simple risk assessment tools along with accessible referral pathways are needed to address the current barriers.
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Affiliation(s)
- Prakash Poudel
- Centre for Oral Health Outcomes and Research Translation (COHORT), Liverpool, New South Wales (NSW), 2170, Australia. .,School of Nursing & Midwifery, Western Sydney University, Campbelltown, NSW, 2560, Australia. .,South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia. .,Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia.
| | - Rhonda Griffiths
- School of Nursing & Midwifery, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Vincent W Wong
- South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia.,Faculty of Medicine, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University Campbelltown Campus, Campbelltown, NSW, 2751, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.,Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia
| | - Jeff R Flack
- South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia.,Faculty of Medicine, University of New South Wales, Kensington, NSW, 2052, Australia.,Diabetes Centre Bankstown-Lidcombe Hospital, Bankstown, NSW, 2200, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Chee L Khoo
- Health focus Family Practice, Ingleburn, NSW, 2565, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes and Research Translation (COHORT), Liverpool, New South Wales (NSW), 2170, Australia.,School of Nursing & Midwifery, Western Sydney University, Campbelltown, NSW, 2560, Australia.,South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia.,University of Sydney, Camperdown, NSW, 2050, Australia
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Guivarc’h M, Saliba-Serre B, Le Coz P, Bukiet F. A cross-sectional analysis of patient care pathways and profiles in a dental emergency department. Int Dent J 2020; 70:21-28. [DOI: 10.1111/idj.12516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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12
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Laniado N, Brow AR, Tranby E, Badner VM. Trends in non‐traumatic dental emergency department use in New York and New Jersey: a look at Medicaid expansion from both sides of the Hudson River. J Public Health Dent 2019; 80:9-13. [DOI: 10.1111/jphd.12343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/27/2019] [Accepted: 08/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Nadia Laniado
- Department of DentistryAlbert Einstein College of Medicine Bronx NY USA
- Department of Epidemiology & Population HealthAlbert Einstein College of Medicine Bronx NY USA
| | - Avery R. Brow
- DentaQuest Partnership for Oral Health Advancement Boston MA USA
| | - Eric Tranby
- DentaQuest Partnership for Oral Health Advancement Boston MA USA
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13
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Okunseri C. Limiting Dental Benefits May Lead to Hospital Emergency Department Visits for Nontraumatic Dental Conditions. J Evid Based Dent Pract 2018; 18:185-186. [DOI: 10.1016/j.jebdp.2018.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vickery KD, Shippee ND, Menk J, Owen R, Vock DM, Bodurtha P, Soderlund D, Hayward RA, Davis MM, Connett J, Linzer M. Integrated, Accountable Care For Medicaid Expansion Enrollees: A Comparative Evaluation of Hennepin Health. Med Care Res Rev 2018; 77:46-59. [DOI: 10.1177/1077558718769481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hennepin Health, a Medicaid accountable care organization, began serving early expansion enrollees (very low-income childless adults) in 2012. It uses an integrated care model to address social and behavioral needs. We compared health care utilization in Hennepin Health with other Medicaid managed care in the same area from 2012 to 2014, controlling for demographics, chronic conditions, and enrollment patterns. Homelessness and substance use were higher in Hennepin Health. Overall adjusted results showed Hennepin Health had 52% more emergency department visits and 11% more primary care visits than comparators. Over time, modeling a 6-month exposure to Hennepin Health, emergency department and primary care visits decreased and dental visits increased; hospitalizations decreased nonsignificantly but increased among comparators. Subgroup analysis of high utilizers showed lower hospitalizations in Hennepin Health. Integrated, accountable care under Medicaid expansion showed some desirable trends and subgroup benefits, but overall did not reduce acute health care utilization versus other managed care.
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Affiliation(s)
| | | | | | - Ross Owen
- Health Strategy Director, Hennepin County, Minneapolis, MN, USA
| | | | - Peter Bodurtha
- Hennepin County Center of Innovation and Excellence, Minneapolis, MN, USA
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15
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Brondani M, Ahmad SH. The 1% of emergency room visits for non-traumatic dental conditions in British Columbia: Misconceptions about the numbers. Canadian Journal of Public Health 2017; 108:e279-e281. [PMID: 28910250 DOI: 10.17269/cjph.108.5915] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 05/17/2017] [Accepted: 03/11/2017] [Indexed: 11/17/2022]
Abstract
In Canada, about 1% of all emergency room (ER) visits in a given year are made by patients with a primary diagnosis of a non-traumatic, non-urgent and yet preventable condition, such as tooth decay. This percentage is typically dismissed as irrelevant. Using 2013-2014 British Columbia data on ER use from the Canadian Institute for Health Information, however, we argue that the 1% figure (and its associated cost) has to be considered beyond its percentage value. In 2013-2014 alone, 12 357 non-traumatic dental visits were made to ERs in BC representing 1% of the total number of ER visits at a cost of $154.8 million to the taxpayers (across Canada, all visits to ER cost $1.8 billion/year). But the vast majority of these dental visits are discharged while the oral problem likely persists, hence taxpayer dollars are wasted. The belief that these dental-related ER visits are insignificant within the total cost for the health care system is misleading: treatment is not given, the problem is not resolved, and yet there is a high cost to taxpayers and to the society at large. Public health resources should be reallocated.
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Affiliation(s)
- Mario Brondani
- Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Syed H Ahmad
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
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16
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Mohamed A, Alhanti B, McCullough M, Goodin K, Roling K, Glickman L. Temporal association of implementation of the Arizona Health Care Cost Containment System (AHCCCS) with changes in dental-related emergency department visits in Maricopa County from 2006 to 2012. J Public Health Dent 2017; 78:49-55. [DOI: 10.1111/jphd.12238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 06/17/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Kate Goodin
- Public Health, Maricopa County; Phoenix AZ USA
| | - Kirsten Roling
- California Oral Health Coalition for the Aging & Developmentally Disabled; San Diego CA USA
| | - Larry Glickman
- Comparative Pathobiology; Purdue University College of Veterinary Medicine; West Lafayette IN USA
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17
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Barnett T, Hoang H, Stuart J, Crocombe L. The relationship of primary care providers to dental practitioners in rural and remote Australia. BMC Health Serv Res 2017; 17:515. [PMID: 28764806 PMCID: PMC5540496 DOI: 10.1186/s12913-017-2473-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 07/25/2017] [Indexed: 11/17/2022] Open
Abstract
Background Rural residents have poorer oral health and more limited access to dental services than their city counterparts. In rural communities, health care professionals often work in an extended capacity due to the needs of the community and health workforce shortages in these areas. Improved links and greater collaboration between resident rural primary care and dental practitioners could help improve oral health service provision such that interventions are both timely, effective and lead to appropriate follow-up and referral. This study examined the impact oral health problems had on primary health care providers; how primary care networks could be more effectively utilised to improve the provision of oral health services to rural communities; and identified strategies that could be implemented to improve oral health. Methods Case studies of 14 rural communities across three Australian states. Between 2013 and 2016, 105 primary and 12 dental care providers were recruited and interviewed. Qualitative data were analysed in Nvivo 10 using thematic analysis. Quantitative data were subject to descriptive analysis using SPSSv20. Results Rural residents presented to primary care providers with a range of oral health problems from “everyday” to “10 per month”. Management by primary care providers commonly included short-term pain relief, antibiotics, and advice that the patient see a dentist. The communication between non-dental primary care providers and visiting or regional dental practitioners was limited. Participants described a range of strategies that could contribute to better oral health and oral health oral services in their communities. Conclusions Rural oral health could be improved by building oral health capacity of non-dental care providers; investing in oral health promotion and prevention activities; introducing more flexible service delivery practices to meet the dental needs of both public and private patients; and establishing more effective communication and referral pathways between rural primary and visiting/regional dental care providers. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2473-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tony Barnett
- Centre of Research Excellence in Primary Oral Health Care, Centre for Rural Health, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, TAS, 7250, Australia
| | - Ha Hoang
- Centre of Research Excellence in Primary Oral Health Care, Centre for Rural Health, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, TAS, 7250, Australia.
| | - Jackie Stuart
- Centre of Research Excellence in Primary Oral Health Care, Centre for Rural Health, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, TAS, 7250, Australia
| | - Len Crocombe
- Centre of Research Excellence in Primary Oral Health Care, Centre for Rural Health, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, TAS, 7250, Australia
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Chalmers NI. Racial Disparities in Emergency Department Utilization for Dental/Oral Health-Related Conditions in Maryland. Front Public Health 2017; 5:164. [PMID: 28770189 PMCID: PMC5515044 DOI: 10.3389/fpubh.2017.00164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/22/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives Hospital emergency departments (EDs) are a place where many Americans seek treatment of dental conditions. Racial and ethnic minorities consistently have higher rates of ED utilization than whites for dental conditions. The reasons for these disparities and significant public health concerns are investigated less often. In this paper, we measure trends in racial disparities in ED discharges for dental conditions in Maryland from 2010 to 2013. To understand these disparities, we also describe differences between racial groups in age, gender, income, location, payer, comorbidities, and the availability of dental care. Methods 2010–2013 State Emergency Department Data for Maryland were used in the analysis. Rates per 100,000 of the population are calculated using information from census population estimates. Cost-to-charge ratios are used to estimate the costs of ED discharges. Dental/oral health-related conditions (DOHRC) are defined as discharge diagnoses of ICD-9-CM codes 520.0 through 529.9. Descriptive statistics and fixed effects logistic regression models with a rare event correction are used to analyze the data. Results Blacks, especially females aged 25–34, have larger proportions of total ED discharges due to DOHRC, and higher population rates of DOHRC, than any other racial or ethnic group. In 2013, Blacks represented 30% of Maryland’s population and accounted for 52% of ED costs for DOHRC. Hispanics and those of other races have much lower rates of DOHRC discharges. The regression results show that the high proportion of DOHRC discharges among Blacks may be explained by the concentration of Blacks in low-income central cities with less access to dental care. Conclusion There are significant racial disparities in the ED utilization for DOHRC in Maryland. These disparities reflect the lack of access to dental care due to both cost and geographic limitations. This results in high healthcare costs and ineffective solutions for patients. Addressing oral health disparities will require policy solutions that are targeted to the populations most at need, and action plans that combine community and state level efforts.
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Affiliation(s)
- Natalia I Chalmers
- Analytics and Publication, DentaQuest Institute, Columbia, MD, United States
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Relationships between dental personnel and non-dental primary health care providers in rural and remote Queensland, Australia: dental perspectives. BMC Oral Health 2017. [PMID: 28629349 PMCID: PMC5477414 DOI: 10.1186/s12903-017-0389-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Collaboration between dental practitioners and non-dental primary care providers has the potential to improve oral health care for people in rural and remote communities, where access to oral health services is limited. However, there is limited research on collaboration between these professional disciplines. The purpose of this paper was to explore the relationships between dental practitioners and non-dental primary care providers from rural and remote areas of Queensland and to identify strategies that could improve collaboration between these disciplines from the perspective of dental participants. METHODS Semi-structured interviews were conducted between 2013 and 2015 with visiting, local and regional dental practitioners (n = 12) who had provided dental services to patients from eight rural and remote Queensland communities that did not have a resident dentist. Participants were purposely recruited through a snow ball sampling technique. Interview data were analysed using thematic analysis with the assistance of QSR Nvivo v.10. RESULTS Four major themes emerged from the data: (1) Communication between dental practitioners and rural primary care providers; (2) Relationships between dental and primary care providers; (3) Maintenance of professional dualism; (4) Strategies to improve interprofessional relationships (with subthemes: face to face meetings; utilisation of technology; oral health training for primary care providers; and having a community based oral health contact person). Participants observed that there was a lack of communication between the dental providers who saw patients from these rural communities and the primary care providers who worked in each community. This was attributed to poor communication, the high turnover of staff and the siloed behaviours of some practitioners. Visiting dental practitioners were likely to have stronger professional relationships with hospital nursing, administrative and allied health care staff who were often long term residents of the community. CONCLUSIONS The findings suggest that there was little relationship between the dental personnel and primary care providers. Interprofessional collaboration between dental care providers and non-dental rural primary care providers in the rural and remote communities sampled could be improved by having regular face to face meetings between practitioners from across the health disciplines, providing oral health education to primary care providers, establishing and maintaining effective communication and referral pathways, and exploring a greater role for tele-dentistry.
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Figueiredo R, Fournier K, Levin L. Emergency department visits for dental problems not associated with trauma in Alberta, Canada. Int Dent J 2017; 67:378-383. [PMID: 28574193 DOI: 10.1111/idj.12315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The objective of this report was to describe the frequency of emergency department (ED) visits for dental problems not associated with trauma (DPNAT) in Alberta, Canada, over a 5-year period. METHODS In Alberta, ED visits for DPNAT between 1 January 2011 and 30 April 2016 were identified using the codes from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA). The codes for DPNAT range from K00 to K14, described as diseases of the oral cavity, salivary glands and jaws. The data were gathered from the National Ambulatory Care Reporting System (NACRS) database and from the Alberta Real Time Syndromic Surveillance Net (ARTSSN). The information gathered on ED visits for DPNAT was related to the primary diagnosis of the discharge disposition of the visits. RESULTS During the study period, there were a total of 147,357 ED visits for DPNAT in Alberta. The visits were made by 111,362 individuals, representing 1.3 visits per person. Among all ED visits, a prevalence of 1.2% of ED visits for DPNAT was observed. The most prevalent primary diagnosis of ED visits for DPNAT was for diseases of pulp and periapical tissues (K04), such as periapical abscess, representing 45.0% of all visits, followed by disorders of teeth and supporting structures (K08), such as toothache, representing 18.8% of all visits. The majority of the visits were made by patients from 20 to 44 years of age (52.2%). North and Calgary Alberta Health Service (AHS) Zones were those with the highest occurrence of ED visits (31.9% and 24.5%, respectively). ED visits for dental problems were more common than visits for other general health conditions, such as diabetes and asthma. CONCLUSION The frequency of ED visits for DPNAT suggests barriers faced by the population in accessing dental care resources, especially for urgent dental needs. Policy efforts and political will are needed to provide alternative options for seeking emergency dental care.
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Affiliation(s)
- Rafael Figueiredo
- Alberta Health Services, Edmonton, AB, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kerri Fournier
- Surveillance & Reporting, Alberta Health Services, Edmonton, AB, Canada
| | - Liran Levin
- Division of Periodontology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Mann RS, Marcenes W, Gillam DG. Is there a role for community pharmacists in promoting oral health? Br Dent J 2017; 218:E10. [PMID: 25766194 DOI: 10.1038/sj.bdj.2015.172] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 11/09/2022]
Abstract
AIM The main aim of the present study was to investigate whether pharmacists recognised that they have a role in the promotion of oral health advice within the community. METHODS A cross sectional survey was conducted using a structured questionnaire which was distributed to randomly selected pharmacies (n = 1,500) in the London area. RESULTS Six hundred and forty-five pharmacies (43%) responded to the initial invitation and 589 (39%) of pharmacy participants acknowledged that pharmacists should have a role in oral health promotion. Participants from 354 pharmacies (23.6%) subsequently agreed to complete the questionnaire. Of those pharmacies completing the questionnaire, 99.4% of the pharmacy participants recognised that there was a role for pharmacists in oral health promotion. Although 91.5% of the pharmacists reported a fairly high level of knowledge for most of the common oral conditions, they also indicated that they were interested in receiving further training on oral conditions through continuing professional development (CPD) courses. A number of the pharmacies (72.5%) expressed a willingness to incorporate oral health promotion within the NHS pharmacy contract. CONCLUSION Pharmacies may be used effectively in oral health promotion by virtue of their frequent contact with members of public. As a result of their established role in promoting and improving the health within the community, it may possible to incorporate oral health within the existing NHS contract.
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Affiliation(s)
- R S Mann
- Dental Public Health/Clinical and Diagnostic Oral Sciences, Institute of Dentistry, Barts and the London School of Medicine and Dentistry London, E1 2AD
| | - W Marcenes
- Dental Public Health/Clinical and Diagnostic Oral Sciences, Institute of Dentistry, Barts and the London School of Medicine and Dentistry London, E1 2AD
| | - D G Gillam
- Centre for Adult Oral Health, 4th Floor, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, QMUL, London, E1 2AD
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Singhal A, Caplan DJ, Jones MP, Momany ET, Kuthy RA, Buresh CT, Isman R, Damiano PC. Eliminating Medicaid adult dental coverage in California led to increased dental emergency visits and associated costs. Health Aff (Millwood) 2016; 34:749-56. [PMID: 25941275 DOI: 10.1377/hlthaff.2014.1358] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dental coverage for adults is an elective benefit under Medicaid. As a result of budget constraints, California Medicaid eliminated its comprehensive adult dental coverage in July 2009. We examined the impact of this policy change on emergency department (ED) visits by Medicaid-enrolled adults for dental problems in the period 2006-11. We found that the policy change led to a significant and immediate increase in dental ED use, amounting to more than 1,800 additional dental ED visits per year. Young adults, members of racial/ethnic minority groups, and urban residents were disproportionately affected by the policy change. Average yearly costs associated with dental ED visits increased by 68 percent. The California experience provides evidence that eliminating Medicaid adult dental benefits shifts dental care to costly EDs that do not provide definitive dental care. The population affected by the Medicaid adult dental coverage policy is increasing as many states expand their Medicaid programs under the ACA. Hence, such evidence is critical to inform decisions regarding adult dental coverage for existing Medicaid enrollees and expansion populations.
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Affiliation(s)
- Astha Singhal
- Astha Singhal is a PhD candidate in the Department of Preventive and Community Dentistry, College of Dentistry, and a research assistant at the Public Policy Center, both at the University of Iowa, in Iowa City
| | - Daniel J Caplan
- Daniel J. Caplan is a professor and department executive officer in the Department of Preventive and Community Dentistry, College of Dentistry, at the University of Iowa
| | - Michael P Jones
- Michael P. Jones is a professor in the Department of Biostatistics, College of Public Health, at the University of Iowa
| | - Elizabeth T Momany
- Elizabeth T. Momany is an associate research scientist at the Public Policy Center, University of Iowa
| | - Raymond A Kuthy
- Raymond A. Kuthy is a professor in the Department of Preventive and Community Dentistry, College of Dentistry, at the University of Iowa
| | - Christopher T Buresh
- Christopher T. Buresh is an associate professor in the Department of Emergency Medicine, College of Medicine, at the University of Iowa
| | - Robert Isman
- Robert Isman is a dental program consultant in the Medi-Cal Dental Services Division of the California Department of Health Care Services, in Sacramento
| | - Peter C Damiano
- Peter C. Damiano is a professor in the Department of Preventive and Community Dentistry, College of Dentistry, and director of the Public Policy Center, both at the University of Iowa
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Salomon D, Heidel RE, Kolokythas A, Miloro M, Schlieve T. Does Restriction of Public Health Care Dental Benefits Affect the Volume, Severity, or Cost of Dental-Related Hospital Visits? J Oral Maxillofac Surg 2016; 75:467-474. [PMID: 27875708 DOI: 10.1016/j.joms.2016.10.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 10/05/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE On July 1, 2012, the Illinois legislature passed the Save Medicaid Access and Resources Together (SMART) Act, which restricts adult public dental insurance coverage to emergency-only treatment. The purpose of this study was to measure the effect of this restriction on the volume, severity, and treatment costs of odontogenic infections in an urban hospital. MATERIALS AND METHODS A retrospective cohort study of patients presenting for odontogenic pain or infection at the University of Illinois Hospital was performed. Data were collected using related International Classification of Diseases, Ninth Revision codes from January 1, 2011 through December 31, 2013 and divided into 2 cohorts over consecutive 18-month periods. Outcome variables included age, gender, insurance status, oral and maxillofacial surgery (OMS) consultation, imaging, treatment, treatment location, number of hospital admission days, and inpatient care level. Severity was determined by the presence of OMS consultation, incision and drainage, hospital admission, and cost per encounter. Hospital charges were used to compare the cost of care between cohorts. Between-patients statistics were used to compare risk factors and outcomes between cohorts. RESULTS Of 5,192 encounters identified, 1,405 met the inclusion criteria. There were no significant differences between cohorts for age (P = .28) or gender (P = .43). After passage of the SMART Act, emergency department visits increased 48%, surgical intervention increased 100%, and hospital admission days increased 128%. Patients were more likely to have an OMS consult (odds ratio [OR] = 1.42; 95% confidence interval [CI], 1.11-1.81), an incision and drainage (OR = 1.48; 95% CI, 1.13-1.94), and a longer hospital admission (P = .04). The average cost per encounter increased by 20% and the total cost of care increased by $1.6 million. CONCLUSION After limitation of dental benefits, there was an increase in the volume and severity of odontogenic infections. In addition, there was an escalated health care cost. The negative public health effects and increased economic impact of eliminating basic dental care show the importance of affordable and accessible preventative oral health care.
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Affiliation(s)
- David Salomon
- Resident, Department of Oral and Maxillofacial Surgery, University of Illinois, Chicago, IL
| | - R Eric Heidel
- Assistant Professor of Biostatistics, Department of Surgery, Office of Medical Education, Research, and Development, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Antonia Kolokythas
- Department Chair, Department of Oral and Maxillofacial Surgery, University of Rochester Medical Center, Rochester, NY
| | - Michael Miloro
- Department Head and Professor, Department of Oral and Maxillofacial Surgery, University of Illinois, Chicago, IL
| | - Thomas Schlieve
- Assistant Professor, Department of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, Dallas, TX.
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Marshman Z, Broomhead T, Rodd HD, Jones K, Burke D, Baker SR. Who attends a Children's Hospital Emergency Department for dental reasons? A two-step cluster analysis approach. Community Dent Oral Epidemiol 2016; 45:49-58. [DOI: 10.1111/cdoe.12258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/30/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Z. Marshman
- School of Clinical Dentistry; University of Sheffield; Sheffield UK
| | - T. Broomhead
- School of Clinical Dentistry; University of Sheffield; Sheffield UK
| | - H. D. Rodd
- School of Clinical Dentistry; University of Sheffield; Sheffield UK
| | - K. Jones
- Public Health England; Sheffield UK
| | - D. Burke
- Sheffield Children's NHS Foundation Trust; Western Bank; Sheffield UK
| | - S. R. Baker
- School of Clinical Dentistry; University of Sheffield; Sheffield UK
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Barnett T, Hoang H, Stuart J, Crocombe L. “Sorry, I'm not a dentist”: perspectives of rural GPs on oral health in the bush. Med J Aust 2016; 204:26. [DOI: 10.5694/mja15.00740] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/01/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Tony Barnett
- Centre for Rural Health, University of Tasmania, Launceston, TAS
| | - Ha Hoang
- Centre for Rural Health, University of Tasmania, Launceston, TAS
| | - Jackie Stuart
- Centre for Rural Health, University of Tasmania, Launceston, TAS
| | - Leonard Crocombe
- Centre for Rural Health, University of Tasmania, Launceston, TAS
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Figueiredo R, Dempster L, Quiñonez C, Hwang SW. Emergency Department Use for Dental Problems among Homeless Individuals: A Population-Based Cohort Study. J Health Care Poor Underserved 2016; 27:860-8. [PMID: 27180713 PMCID: PMC4889437 DOI: 10.1353/hpu.2016.0081] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate emergency department (ED) visits for dental problems among Toronto's homeless population (Ontario, Canada). METHODS A random sample of 1,189 homeless was recruited from shelters and meal programs. Emergency department visits for non-traumatic dental problems (ICD-10-CA codes K00-K14) were identified using participants' health insurance number, during 2005-2009. Age- and sex-matched controls were selected from low-income neighborhoods. RESULTS Homeless and matched controls had 182 and 10 ED visits for dental problems, respectively. Homeless people were more significantly more likely (OR=2.27, p=.007) to make ED visit for dental problems compared with controls. Over 80% of the ED visits by homeless people were for odontogenic infections, and 46% of homeless people had more than one such visit. CONCLUSION The high rate of ED visits for dental problems by people who are homeless suggests that access to dental care is inadequate. The large number of repeat visits indicates that ED settings are ineffective for treatment of dental problems.
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Non-traumatic Dental Condition-Related Emergency Department Visits and Associated Costs for Children and Adults with Autism Spectrum Disorders. J Autism Dev Disord 2015; 45:1396-407. [PMID: 25374135 DOI: 10.1007/s10803-014-2298-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We analyzed 2010 US National Emergency Department Sample data and ran regression models to test the hypotheses that individuals with ASD are more likely to have non-traumatic dental condition (NTDC)-related emergency department (ED) visits and to incur greater costs for these visits than those without ASD. There were nearly 2.3 million NTDC-related ED visits in 2010. Less than 1.0% (children) and 2.1% (adults) of all ED visits were for NTDC. There was no significant difference in NTDC-related ED visits or costs for children by ASD status. Adults with ASD had significantly lower odds of NTDC-related ED visits (OR 0.39; 95% CI 0.29, 0.52; p < 0.001) but incurred significantly greater mean costs for NTDC-related ED visits (p < 0.006) than did adults without ASD.
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Barnett T, Hoang H, Stuart J, Crocombe L. Non-dental primary care providers' views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study. BMJ Open 2015; 5:e009341. [PMID: 26515687 PMCID: PMC4636644 DOI: 10.1136/bmjopen-2015-009341] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. DESIGN Qualitative study with semistructured interviews and thematic analysis. SETTING Four remote communities in outback Queensland, Australia. PARTICIPANTS 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities. RESULTS In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health. CONCLUSIONS Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities.
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Affiliation(s)
- Tony Barnett
- Centre of Research Excellence in Primary Oral Health Care, Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Ha Hoang
- Centre of Research Excellence in Primary Oral Health Care, Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Jackie Stuart
- Centre of Research Excellence in Primary Oral Health Care, Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Len Crocombe
- Centre of Research Excellence in Primary Oral Health Care, Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
- Australian Research Centre for Population Oral Health, School of Dentistry, University of Adelaide, Adelaide, South Australia, Australia
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Darling BG, Singhal A, Kanellis MJ. Emergency department visits and revisits for nontraumatic dental conditions in Iowa. J Public Health Dent 2015; 76:122-8. [DOI: 10.1111/jphd.12120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 07/31/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | - Astha Singhal
- Henry M. Goldman School of Dentistry; Boston University; Boston MA USA
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Figueiredo RLF, Singhal S, Dempster L, Hwang SW, Quinonez C. The accuracy of International Classification of Diseases coding for dental problems not associated with trauma in a hospital emergency department. J Public Health Dent 2015. [PMID: 26223987 DOI: 10.1111/jphd.12115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Emergency department (ED) visits for nontraumatic dental conditions (NTDCs) may be a sign of unmet need for dental care. The objective of this study was to determine the accuracy of the International Classification of Diseases codes (ICD-10-CA) for ED visits for NTDC. METHODS ED visits in 2008-2099 at one hospital in Toronto were identified if the discharge diagnosis in the administrative database system was an ICD-10-CA code for a NTDC (K00-K14). A random sample of 100 visits was selected, and the medical records for these visits were reviewed by a dentist. The description of the clinical signs and symptoms were evaluated, and a diagnosis was assigned. This diagnosis was compared with the diagnosis assigned by the physician and the code assigned to the visit. RESULTS The 100 ED visits reviewed were associated with 16 different ICD-10-CA codes for NTDC. Only 2 percent of these visits were clearly caused by trauma. The code K0887 (toothache) was the most frequent diagnostic code (31 percent). We found 43.3 percent disagreement on the discharge diagnosis reported by the physician, and 58.0 percent disagreement on the code in the administrative database assigned by the abstractor, compared with what it was suggested by the dentist reviewing the chart. CONCLUSION There are substantial discrepancies between the ICD-10-CA diagnosis assigned in administrative databases and the diagnosis assigned by a dentist reviewing the chart retrospectively. However, ICD-10-CA codes can be used to accurately identify ED visits for NTDC.
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Affiliation(s)
| | - Sonica Singhal
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Laura Dempster
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON, Canada
| | - Carlos Quinonez
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
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Wides C, Alam SR, Mertz E. Shaking up the dental safety-net: elimination of optional adult dental Medicaid benefits in California. J Health Care Poor Underserved 2015; 25:151-64. [PMID: 24583494 DOI: 10.1353/hpu.2014.0072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In July 2009, California eliminated funding for most adult non-emergency Medicaid dental benefits (Denti-Cal). This paper presents the findings from a qualitative assessment of the impacts of the Denti-Cal cuts on California's oral health safety-net. Interviews were conducted with dental safety-net providers throughout the state, including public health departments, community health centers, dental schools, Native American health clinics, and private providers, and were coded thematically using Atlas.ti. Safety-net providers reported decreased utilization by Denti-Cal-eligible adults, who now primarily seek emergency dental services, and reported shifting to focus on pediatric and privately-insured patients. Significant changes were reported in safety-net clinic finances, operations, and ability to refer. The impact of the Denti-Cal cuts has been distributed unevenly across the safety-net, with private providers and County Health Departments bearing the highest burden.
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Sun BC, Chi DL, Schwarz E, Milgrom P, Yagapen A, Malveau S, Chen Z, Chan B, Danner S, Owen E, Morton V, Lowe RA. Emergency department visits for nontraumatic dental problems: a mixed-methods study. Am J Public Health 2015; 105:947-55. [PMID: 25790415 DOI: 10.2105/ajph.2014.302398] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We documented emergency department (ED) visits for nontraumatic dental problems and identified strategies to reduce ED dental visits. METHODS We used mixed methods to analyze claims in 2010 from a purposive sample of 25 Oregon hospitals and Oregon's All Payer All Claims data set and interviewed 51 ED dental visitors and stakeholders from 6 communities. RESULTS Dental visits accounted for 2.5% of ED visits and represented the second-most-common discharge diagnosis in adults aged 20 to 39 years, were associated with being uninsured (odds ratio [OR] = 5.2 [reference: commercial insurance]; 95% confidence interval [CI] = 4.8, 5.5) or having Medicaid insurance (OR = 4.0; 95% CI = 3.7, 4.2), resulted in opioid (56%) and antibiotic (56%) prescriptions, and generated $402 (95% CI = $396, $408) in hospital costs per visit. Interviews revealed health system, community, provider, and patient contributors to ED dental visits. Potential solutions provided by interviewees included Medicaid benefit expansion, care coordination, water fluoridation, and patient education. CONCLUSIONS Emergency department dental visits are a significant and costly public health problem for vulnerable individuals. Future efforts should focus on implementing multilevel interventions to reduce ED dental visits.
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Affiliation(s)
- Benjamin C Sun
- Benjamin C. Sun, Annick Yagapen, Susan Malveau, and Ben Chan are with Department of Emergency Medicine, Oregon Health and Science University (OHSU), Portland. Robert A. Lowe is with the Department of Medical Informatics and Clinical Epidemiology, OHSU. Donald L. Chi and Peter Milgrom are with Department of Oral Health Sciences, University of Washington, Seattle. Eli Schwarz is with School of Dentistry, OHSU. Zunqui Chen is with Department of Public Health and Preventive Medicine, OHSU. Sankirtana Danner is with Oregon Rural Practice-Based Research Network, OHSU. Erin Owen is with Slocum Research and Education Foundation, Eugene, OR. Vickie Morton is with Financial Services, OHSU
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Hong L, Liu Y, Hottel T, Hoff G, Cai J. Neighborhood socio-economic context and emergency department visits for dental care in a U.S. Midwestern metropolis. Public Health 2015; 129:252-7. [DOI: 10.1016/j.puhe.2014.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 10/19/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
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Neely M, Jones JA, Rich S, Gutierrez LS, Mehra P. Effects of cuts in Medicaid on dental-related visits and costs at a safety-net hospital. Am J Public Health 2014; 104:e13-6. [PMID: 24825223 DOI: 10.2105/ajph.2014.301903] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We used data from Boston Medical Center, Massachusetts, to determine whether dental-related emergency department (ED) visits and costs increased when Medicaid coverage for adult dental care was reduced in July 2010. In this retrospective study of existing data, we examined the safety-net hospital's dental-related ED visits and costs for 3 years before and 2 years after Massachusetts Health Care Reform. Dental-related ED visits increased 2% the first and 14% the second year after Medicaid cuts. Percentage increases were highest among older adults, minorities, and persons receiving charity care, Medicaid, and Medicare.
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Affiliation(s)
- Martha Neely
- The authors are with the Boston University Henry M. Goldman School of Dental Medicine, Boston, MA. Pushkar Mehra is also with Boston Medical Center, Boston
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Buhrow SM, Buhrow JA. The unintended consequence of a "cottage industry". J Oral Maxillofac Surg 2014; 72:1233-4. [PMID: 24613029 DOI: 10.1016/j.joms.2014.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Jack A Buhrow
- Program Director and Founder, Banner Good Samaritan Medical Center, OMFS Residency Program, Phoenix, AZ
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Walker A, Probst JC, Martin AB, Bellinger JD, Merchant A. Analysis of hospital-based emergency department visits for dental caries in the United States in 2008. J Public Health Dent 2013; 74:188-94. [DOI: 10.1111/jphd.12045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 10/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Andre Walker
- Institute for Partnerships to Eliminate Health Disparities; Arnold School of Public Health; University of South Carolina; Columbia SC USA
| | - Janice C. Probst
- Department of Health Services Policy and Management; Arnold School of Public Health; University of South Carolina; Columbia SC USA
- South Carolina Rural Health Research Center; Columbia SC USA
| | - Amy B. Martin
- Department of Health Services Policy and Management; Arnold School of Public Health; University of South Carolina; Columbia SC USA
- South Carolina Rural Health Research Center; Columbia SC USA
| | - Jessica D. Bellinger
- Department of Health Services Policy and Management; Arnold School of Public Health; University of South Carolina; Columbia SC USA
- South Carolina Rural Health Research Center; Columbia SC USA
| | - Anwar Merchant
- Department of Epidemiology and Biostatistics; Arnold School of Public Health; University of South Carolina; Columbia SC USA
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Okunseri C, Okunseri E, Fischer MC, Sadeghi SN, Xiang Q, Szabo A. Nontraumatic dental condition-related visits to emergency departments on weekdays, weekends and night hours: findings from the National Hospital Ambulatory Medical Care survey. Clin Cosmet Investig Dent 2013; 5:69-76. [PMID: 24039453 PMCID: PMC3770522 DOI: 10.2147/ccide.s49191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To determine whether the rates of nontraumatic dental condition (NTDC)-related emergency department (ED) visits are higher during the typical working hours of dental offices and lower during night hours, as well as the associated factors. Methods We analyzed data from the National Hospital Ambulatory Medical Care Survey for 1997 through 2007 using multivariate binary and polytomous logistic regression adjusted for survey design to determine the effect of predictors on specified outcome variables. Results Overall, 4,726 observations representing 16.4 million NTDC-related ED visits were identified. Significant differences in rates of NTDC-related ED visits were observed with 40%–50% higher rates during nonworking hours and 20% higher rates on weekends than the overall average rate of 170 visits per hour. Compared with 19–33 year olds, subjects < 18 years old had significantly higher relative rates of NTDC-related ED visits during nonworking hours [relative rate ratio (RRR) = 1.6 to 1.8], whereas those aged 73 and older had lower relative rates during nonworking hours (RRR = 0.4; overall P = 0.0005). Compared with those having private insurance, Medicaid and self-pay patients had significantly lower relative rates of NTDC visits during nonworking and night hours (RRR = 0.6 to 0.7, overall P < 0.0003). Patients with a dental reason for visit were overrepresented during the night hours (RRR = 1.3; overall P = 0.04). Conclusion NTDC-related visits to ED occurred at a higher rate during nonworking hours and on weekends and were significantly associated with age, patient-stated reason for visit and payer type.
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Affiliation(s)
- Christopher Okunseri
- Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA
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Higbea RJ, Palumbo CH, Pearl SA, Byrne MJ, Wise J. Dentists’ Partnership Of Michigan’s Calhoun County: A Care Model For Uninsured Populations. Health Aff (Millwood) 2013; 32:1646-51. [DOI: 10.1377/hlthaff.2013.0159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Raymond J. Higbea
- Raymond J. Higbea is an assistant professor of public affairs and administration at Western Michigan University, in Kalamazoo
| | - Charles H. Palumbo
- Charles H. Palumbo is the dental director at Community HealthCare Connections, in Battle Creek, Michigan
| | - Samantha A. Pearl
- Samantha A. Pearl ( ) is the executive director of Community HealthCare Connections
| | - Mary Jo Byrne
- Mary Jo Byrne is the executive director of Fountain Clinic, in Marshall, Michigan
| | - Jill Wise
- Jill Wise is the director of community projects at Family Health Center of Battle Creek, in Michigan
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Ramraj CC, Quiñonez CR. Emergency room visits for dental problems among working poor Canadians. J Public Health Dent 2013; 73:210-6. [DOI: 10.1111/jphd.12015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 03/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Chantel C. Ramraj
- Discipline of Dental Public Health; Faculty of Dentistry; University of Toronto; Toronto ON Canada
| | - Carlos R. Quiñonez
- Discipline of Dental Public Health; Faculty of Dentistry; University of Toronto; Toronto ON Canada
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Cohen LA. Expanding the physician's role in addressing the oral health of adults. Am J Public Health 2013; 103:408-12. [PMID: 23327256 PMCID: PMC3673507 DOI: 10.2105/ajph.2012.300990] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2012] [Indexed: 12/30/2022]
Abstract
Many disadvantaged adults visit physicians or hospital emergency departments to receive relief from dental pain. Physicians also see patients with general questions or concerns about their oral health. Unfortunately, because physicians generally have received little oral health training, patients often do not receive comprehensive emergency services or appropriate counseling. This situation has begun to change, as there has been a growing sentiment among the dental and medical communities that better integration and coordination between medicine and dentistry would be beneficial. Reports from the Institute of Medicine and professional associations and foundations reflect the need for better integration. I have outlined the rationale for and progress toward expanding the physician's role in addressing the oral health of adults.
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Affiliation(s)
- Leonard A Cohen
- Division of Dental Public Health, University of Maryland Dental School, Baltimore, MD 21201, USA.
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Lee HH, Lewis CW, Saltzman B, Starks H. Visiting the emergency department for dental problems: trends in utilization, 2001 to 2008. Am J Public Health 2012; 102:e77-83. [PMID: 22994252 DOI: 10.2105/ajph.2012.300965] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested the hypothesis that between 2001 and 2008, Americans increasingly relied upon emergency departments (EDs) for dental care. METHODS Data from 2001 through 2008 were collected from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Population-based visit rates for dental problems, and, for comparison, asthma, were calculated using annual US Census Bureau estimates. As part of the analysis, we described patient characteristics associated with large increases in ED dental utilization. RESULTS Dental visit rates increased most dramatically for the following subpopulations: those aged 18 to 44 years (7.2-12.2 per 1000, P < .01); Blacks (6.0-10.4 per 1000, P < .01); and the uninsured (9.5-13.2 per 1000, P < .01). Asthma visit rates did not change although dental visit rates increased 59% from 2001 to 2008. CONCLUSIONS There is an increasing trend in ED visits for dental issues, which was most pronounced among those aged 18 to 44 years, the uninsured, and Blacks. Dental visit rates increased significantly although there was no overall change in asthma visit rates. This suggests that community access to dental care compared with medical care is worsening over time.
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Affiliation(s)
- Helen H Lee
- Department of Anesthesiology, University of Washington, Seattle, WA, USA.
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Vargas CM, Casper JS, Altema-Johnson D, Kolasny CR. Oral health trends in Maryland. J Public Health Dent 2012; 72 Suppl 1:S18-22. [PMID: 22433088 DOI: 10.1111/j.1752-7325.2012.00323.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This paper describes the trends in oral health in Maryland over the past decade. METHODS Data were compiled from several surveillance systems and then summarized to assess the trends in oral health in Maryland over the past ten years. RESULTS The percentage of Maryland children with dental sealants increased from 33.8 to 42.8 percent; the percentage of children that have had a dental visit increased from 18.9 to 47.5 percent; and the percentage of children that received "dental treatment" increased from 8.4 to 22.4 percent. CONCLUSIONS Maryland has made considerable progress in improving the oral health care for children covered by Medicaid. The availability of affordable oral health care for new mothers, adults, and elderly persons is a problem that goes beyond the Maryland boundaries. Following national trends, edentulism and deaths due to oral cancer have declined.
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Choi MK. The impact of Medicaid insurance coverage on dental service use. JOURNAL OF HEALTH ECONOMICS 2011; 30:1020-1031. [PMID: 21885138 DOI: 10.1016/j.jhealeco.2011.08.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 07/27/2011] [Accepted: 08/05/2011] [Indexed: 05/31/2023]
Abstract
The new comprehensive health reform, beginning in 2014, will require Medicaid to expand all elements of coverage to individuals with incomes up to 133 percent of the federal poverty line. With millions more individuals gaining eligibility for adult Medicaid dental benefits, generating an unbiased estimate of the elasticity of demand for dental services is critical. The causal relationship between access to adult Medicaid dental benefits and usage of dental services for low-income adults is estimated, using difference-in-differences estimation procedures to exploit the state-level variation in adult Medicaid dental benefits. Results suggest that adult Medicaid dental benefits increase the probability of a dental visit within 12 months by 16.4-22 percent. A variety of robustness checks are invoked to confirm the finding.
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Affiliation(s)
- Moonkyung Kate Choi
- Department of Economics, University of California, 4122 Sproul Hall, Riverside, CA 92521, USA.
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Adhikari S, Blaivas M, Lander L. Comparison of bedside ultrasound and panorex radiography in the diagnosis of a dental abscess in the ED. Am J Emerg Med 2011; 29:790-5. [DOI: 10.1016/j.ajem.2010.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/07/2010] [Accepted: 03/07/2010] [Indexed: 01/04/2023] Open
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Davis EE, Deinard AS, Maïga EWH. Doctor, my tooth hurts: the costs of incomplete dental care in the emergency room. J Public Health Dent 2010; 70:205-10. [PMID: 20337900 DOI: 10.1111/j.1752-7325.2010.00166.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aims to examine the charges and frequency of return visits for treating dental health problems in hospital emergency rooms (ERs) in order to provide a basis for policy discussion concerning cost-effective and appropriate treatment for those without access to private dental services. METHODS Records were abstracted from hospital administrative data systems for dental-related ER visits from five major hospital systems in the Minneapolis-St. Paul metropolitan area during a 1-year period. Data on the number of visits and charges were analyzed by age and type of payor (public or private). Similar data were obtained from records for a commercially insured population from a single large employer. RESULTS There were over 10,000 visits to ERs for dental-related problems with total charges reaching nearly $5 million in 1 year, mainly charged to public programs and reimbursed at about 50 percent. The frequency of repeat visits suggests that while acute pain and infection were treated by the ER physicians, the underlying dental problem often was not resolved. In contrast, a population with commercial dental insurance rarely used hospital ERs for dental problems. CONCLUSIONS Access to preventive and restorative dental care is a critical public health problem in the United States, particularly for those without insurance and those covered by public programs. Public health policy initiatives such as the use of dental therapists should be expanded to improve access and to provide alternatives that offer more complete and less costly care for oral health problems than do hospital ERs.
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Affiliation(s)
- Elizabeth E Davis
- Department of Applied Economics, University of Minnesota, St. Paul, MN 55108-6040, USA.
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Cohen LA, Bonito AJ, Eicheldinger C, Manski RJ, Macek MD, Edwards RR, Khanna N. Comparison of patient visits to emergency departments, physician offices, and dental offices for dental problems and injuries. J Public Health Dent 2010; 71:13-22. [DOI: 10.1111/j.1752-7325.2010.00195.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McIntosh MS, Konzelmann J, Smith J, Kalynych CJ, Wears RL, Schneider H, Wylie T, Kaminski A, Matar-Joseph M. Stabilization and Treatment of Dental Avulsions and Fractures by Emergency Physicians Using Just-in-Time Training. Ann Emerg Med 2009; 54:585-92. [DOI: 10.1016/j.annemergmed.2009.06.510] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 06/03/2009] [Accepted: 06/24/2009] [Indexed: 11/29/2022]
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50
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Durham TM, King KA, Salama FS, Lange BM. Oral health outcomes in an adult dental population: the impact of payment systems. SPECIAL CARE IN DENTISTRY 2009; 29:191-7. [PMID: 19740149 DOI: 10.1111/j.1754-4505.2009.00095.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study compared the effect of payment systems on recall visits and oral health outcomes for four patient payer groups. The authors reviewed recall audit data obtained over a 4-year period. Dental payer groups in the study population differed with respect to dental outcomes. Patients who had recall visits at 1 year or longer had worse outcomes than patients seen more frequently. A Medicaid subgroup with the greatest number of risk factors displayed improved oral health outcomes when seen on a more frequent recall schedule. Study findings suggest that, given the increased risks to maintaining oral health, patients being supported by public-funded programs would benefit from more frequent recalls. Such an emphasis would appear to provide the opportunity to improve outcomes in disadvantaged populations and increase the quality of care offered.
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Affiliation(s)
- Timothy M Durham
- Department of Hospital Dentistry, College of Dentistry, University of Nebraska Medical Center, Lincoln, Nebraska, USA.
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