Dental-Related Use of Hospital Emergency Departments by Hispanics and Non-Hispanics in Florida

Emergency department visits for dental problems among adults with private dental insurance: A national observational study

OBJECTIVE

Dental insurance may be a protective factor in reducing unnecessary emergency department (ED) use for nontraumatic dental pain. The purpose of this study was to 1) characterize patient demographics and identify risk factors associated with ED utilization for dental problems among individuals dually enrolled in medical and dental insurance and 2) investigate antibiotic and opioid prescription patterns among these patients following discharge. Further study of this unique population may provide insight into other causes of unmet dental need beyond lack of dental insurance.

METHODS

Claims data from a large national managed health care plan from 2015 to 2018 were used to evaluate ED use for dental problems in patients with synchronous medical and dental insurance. National counts for ED visits, total visit costs, primary diagnoses, and outpatient treatments for antibiotics and opioids were assessed. Multivariable regression was used to assess any associated demographic and health-related variables.

RESULTS

1492 unique patients were admitted to the ED for dental pain and 429,376 unique patients presented for other symptoms. Utilization rates for nontraumatic dental pain were estimated to be 0.4% of all ED visits, with an average cost of $1487 per visit. Within three days following discharge from the ED, 58% of patients filled an opioid prescription and 38% filled an antibiotic prescription. Patients who presented for dental ED pain were more likely to be younger, live in a ZIP code with a lower median household income, have more medical comorbidities, and receive fewer preventive dental procedures within the prior year.

CONCLUSION

Our findings demonstrate a low rate of ED utilization for nontraumatic dental pain among dentally insured patients and highlight the protective value of prior dental visits for reducing ED use. Given high rates of antibiotic and opioid prescription fill following discharge, comprehensive ED guidelines regarding appropriate antibiotic and opioid treatment pathways may be helpful to provide more definitive care to patients with dental insurance.

Emergency department visits at Rambam health care campus, Israel: non-trauma related dental conditions

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.

Mission of Mercy patient characteristics and dental-related emergency department use

BACKGROUND

Although dental Mission of Mercy (MOM) events have existed for more than 2 decades and are held in more than 30 states, systematic data collection and reporting on patient characteristics, oral health care use patterns, and oral health care needs are lacking.

METHODS

The authors surveyed patients attending the 2016 Florida MOM, asking about their reasons for seeking oral health care, oral health care use, and dental-related emergency department (ED) use. The authors conducted descriptive and multivariable analyses of survey and patient registration data to describe patient characteristics and examine associations between patient characteristics, time to last dental visit, and ED use.

RESULTS

Sixty-six percent of 1,462 study participants reported having orofacial pain; one-third of those were in pain for more than 1 year. Only 18% reported fair or poor overall health, whereas 75% reported fair or poor oral health. Florida MOM attendees who were younger adults, were of non-Hispanic ethnicity, had less than a college education, lived below federal poverty guidelines, and reported poorer oral health were at increased risk of having dental-related ED visits.

CONCLUSIONS

Incorporating systematic data collection into dental MOM events provides important information about the characteristics and oral health care needs of clinic attendees that can be used to develop programs to address oral health care access on the basis of community-specific needs.

PRACTICAL IMPLICATIONS

Community partners are using study data to develop strategies to address unmet oral health care needs. By systematically collecting information about patients who attend dental MOM events, we can obtain valuable information to create awareness about local community oral health care needs and promote efforts to develop sustainable strategies to improve oral health care access and outcomes.

Hospital inpatient admissions for nontraumatic dental conditions among Florida adults, 2006 through 2016

BACKGROUND

In this study, the authors analyzed patterns, trends, and correlates of hospital inpatient admissions for nontraumatic dental conditions (NTDCs) in Florida for the calendar years 2006 through 2016.

METHODS

The study was a retrospective analysis of hospital inpatient admissions for NTDCs throughout Florida. The authors derived data from a database maintained by the Florida Agency for Health Care Administration, the state's primary health policy and planning entity.

RESULTS

There were 26,659 hospital inpatient admissions for NTDCs during the 11-year period. The number of admissions increased from 1,808 in 2006 to 3,542 in 2016, and total charges increased from $46.1 million to $166.5 million. The most common diagnosis was periapical abscess without sinus. Emergency departments were the most frequent source of admission.

CONCLUSIONS

Hospital inpatient admissions for NTDCs are a growing challenge in Florida. If trends continue, hospital inpatient admissions for NTDCs will place an increasing burden on the state's health care system.

PRACTICAL IMPLICATIONS

Increasing numbers of hospital inpatient admissions for NTDCs are largely a consequence of using emergency departments to address dental-related conditions. This growing dental public health concern has major implications for health care resources and outcomes.