Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Am J Emerg Med. 2021 Jun;44:166-170. doi: 10.1016/j.ajem.2021.02.001. Epub 2021 Feb 11.
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.
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.
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.
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.
牙科保险可能是减少因非创伤性牙痛而不必要地使用急诊部（ED）的保护因素。本研究的目的是 1）描述患者人口统计学特征，并确定同时参加医疗和牙科保险的个体中与 ED 利用牙科问题相关的风险因素，2）调查这些患者出院后的抗生素和阿片类药物处方模式。对这一独特人群的进一步研究可能会深入了解除缺乏牙科保险以外导致未满足的牙科需求的其他原因。
使用来自大型全国管理式医疗保健计划的 2015 年至 2018 年的索赔数据，评估同时具有医疗和牙科保险的患者因牙科问题而使用 ED 的情况。评估了 ED 就诊、总就诊费用、主要诊断以及抗生素和阿片类药物的门诊治疗的全国就诊人数。使用多变量回归评估任何相关的人口统计学和健康相关变量。
1492 名患者因牙痛被收入 ED，429376 名患者因其他症状就诊。非创伤性牙痛的利用率估计占所有 ED 就诊的 0.4%，每次就诊的平均费用为 1487 美元。在从 ED 出院后的三天内，58%的患者开了阿片类药物处方，38%的患者开了抗生素处方。因牙科 ED 疼痛就诊的患者更年轻，居住在家庭收入中位数较低的邮政编码区，患有更多的合并症，并且在之前一年中接受的预防性牙科治疗次数更少。
我们的研究结果表明，有牙科保险的患者因非创伤性牙痛而利用 ED 的比率较低，并强调了先前牙科就诊对减少 ED 使用的保护作用。鉴于出院后抗生素和阿片类药物的高处方率，制定关于适当抗生素和阿片类药物治疗途径的综合 ED 指南可能有助于为有牙科保险的患者提供更明确的治疗。
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