Department of Health Care Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA.
Department of Dental Medicine, School of Dental Medicine, University of Nevada, Las Vegas, NV 89106, USA.
Int J Environ Res Public Health. 2019 Sep 30;16(19):3671. doi: 10.3390/ijerph16193671.
This study was designed to examine national trends and evaluate social determinants of health that were associated with the provision of dental services in emergency rooms in the United States between 2007 and 2014. A pooled cross-sectional database of emergency department (ED) visits combined the 2007-2014 waves of the Nationwide Emergency Department Sample. A total of 3,761,958 ED visits with dental conditions were extracted and the principal diagnosis was identified. A series of modified Poisson regression models were used to assess the relationship between patient sociodemographic factors and hospital characteristics, and the likelihood of visiting the ED for a nontraumatic dental reason. Unadjusted descriptive results indicated that there was no apparent increase in the percentage of patients who visited an ED with nontraumatic dental conditions (NTDCs) between 2007 and 2014. The greatest users of EDs for NTDCs were among those who were uninsured and Medicaid beneficiaries relative to persons privately insured. ED visitors were more likely to reside in lower socioeconomic areas (when compared with visitors in the top quartile of the income distribution). Patients in all other age groups were more likely to seek care in an ED for NTDCs relative to those 65 years of age or older. Multiple strategies are required to reduce the use of EDs for routine dental care. This approach will require an interprofessional dialogue and solutions that reduce barriers to receiving dental care.
这项研究旨在考察美国 2007 年至 2014 年间,全国范围内与在急诊室提供牙科服务相关的趋势和评估社会决定因素。通过对急诊部(ED)就诊的 2007-2014 年数据进行合并,建立了一个横断面数据库。共提取了 3761958 例有牙科疾病的 ED 就诊记录,并确定了主要诊断。采用一系列修正泊松回归模型,评估患者社会人口因素和医院特征与非创伤性牙科原因就诊 ED 的可能性之间的关系。未经调整的描述性结果表明,2007 年至 2014 年间,因非创伤性牙科疾病就诊 ED 的患者比例似乎没有明显增加。与私人保险患者相比,无保险和医疗补助受益人的 ED 使用率最高。与收入分布最高四分位数的就诊者相比,ED 就诊者更可能居住在较低社会经济地区。与 65 岁及以上的患者相比,所有其他年龄段的患者更有可能因非创伤性牙科疾病到 ED 就诊。需要采取多种策略来减少因常规牙科护理而使用 ED。这种方法需要进行跨专业对话,并制定减少获得牙科护理障碍的解决方案。