Department of Clinical Services, Room 356, School of Dentistry, Marquette University, P.O. Box 1881, Milwaukee, WI 53201-1881, USA.
J Am Dent Assoc. 2011 May;142(5):540-50. doi: 10.14219/jada.archive.2011.0224.
Medicaid enrollees experience a number of barriers that prevent them from seeking care in dental offices, leading some to repeatedly seek treatment for nontraumatic dental conditions (NTDCs) in emergency departments (EDs) and physicians' offices (POs). The authors examined the rate of return visits to EDs and POs for treatment of NTDCs among Wisconsin Medicaid enrollees and sought to characterize frequent and typical users of such care in this population.
The authors conducted a retrospective analysis of all Wisconsin Medicaid dental claims for NTDCs to EDs and POs from 2001 through 2003. They used finite mixture models, allowing for covariate dependence, to model separate rates of return for NTDC-related visits corresponding to typical and frequent users of EDs and POs.
Overall, 23,999 enrollees had made NTDC-related visits to EDs and POs, with 6.5 percent estimated to be frequent users of such care. Typical and frequent users had a mean (± standard error) rate of return visits of 0.2 ± 0.01 and 4.0 ± 0.08 per year, respectively. Male enrollees and people aged 19 to 42 years were more likely to be frequent users, with African American and Hispanic enrollees having lower odds of being frequent users than did white enrollees. The effect of living in an area with a shortage of dental health care professionals did not affect the likelihood of being a frequent user of EDs and POs for such care.
Male and middle-aged enrollees were significantly more likely to be frequent users of EDs and POs for treatment of NTDCs. Compared with white enrollees, African American and Hispanic enrollees were less likely to be frequent users and had lower rates of recurrent visits for NTDCs among typical users.
Improved access to dental care for Medicaid enrollees that is best managed by dental care providers should reduce the rates of recurrent NTDC-related visits to EDs and POs.
医疗补助计划的参保人在寻求牙科治疗时会遇到许多障碍，这导致一些人反复到急诊室（ED）和医生办公室（PO）治疗非创伤性牙科疾病（NTDC）。作者检查了威斯康星州医疗补助计划参保人因 NTDC 到 ED 和 PO 复诊的比率，并试图描述该人群中这种治疗的频繁和典型使用者的特征。
作者对 2001 年至 2003 年期间威斯康星州医疗补助计划的所有 NTDC 相关 ED 和 PO 牙科索赔进行了回顾性分析。他们使用有限混合模型，允许协变量依赖，为对应于 ED 和 PO 的典型和频繁使用者的 NTDC 相关就诊的单独复诊率建模。
总体而言，23999 名参保人因 NTDC 相关疾病到 ED 和 PO 就诊，其中 6.5%被估计为该类治疗的频繁使用者。典型和频繁使用者的复诊率分别为 0.2 ± 0.01 和 4.0 ± 0.08 年。男性参保人和 19 至 42 岁的人更有可能成为频繁使用者，非裔美国人和西班牙裔参保人成为频繁使用者的可能性低于白人参保人。生活在牙科保健专业人员短缺地区并不会影响成为此类治疗的 ED 和 PO 频繁使用者的可能性。
男性和中年参保人更有可能成为 ED 和 PO 治疗 NTDC 的频繁使用者。与白人参保人相比，非裔美国人和西班牙裔参保人成为频繁使用者的可能性较低，而典型使用者的 NTDC 复发就诊率也较低。
改善医疗补助计划参保人的牙科护理获得机会，最好由牙科护理提供者管理，应降低 ED 和 PO 因 NTDC 相关疾病复诊的比率。
