Emergency Department Visits for Nontraumatic Dental Problems: A Mixed-Methods Study

Journal Name: 
Am.J.Public Health
Authors: 
Sun,B.C.
Chi,D.L.
Schwarz,E.
Milgrom,P.
Yagapen,A.
Malveau,S.
Chen,Z.
Chan,B.
Danner,S.
Owen,E.
Morton,V.
Lowe,R.A.
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. (Am J Public Health. Published online ahead of print March 19, 2015: e1-e9. doi:10.2105/AJPH.2014.302398)
3
19
2015
Pages: 
e1-e9
Keywords: 
20, 2010, Adult, Aged, Claims, clinical, community, cost, data, Dentistry, Diagnosis, education, electronic, Emergencies, Emergency Medicine, epidemiology, Health, hospital, Hospitals, Informatics, Insurance, intervention, Interviews, Medicaid, medical, Medical Informatics, Medicine, Methods, Odds Ratio, Oral Health, Oregon, patient, Patient Education, practice-based research, Prescriptions, Preventive Medicine, provider, Public Health, Research, system, Universities, Washington