医疗补助受益人群中与牙科相关的急诊情况的系统性回顾。
A systematic review of dental-related emergency department among Medicaid beneficiaries.
机构信息
American Institute of Dental Public Health, San Antonio, TX, USA.
CareQuest Institute for Oral Health, Boston, MA, USA.
出版信息
J Public Health Dent. 2021 Dec;81(4):280-289. doi: 10.1111/jphd.12458. Epub 2021 Jun 2.
OBJECTIVES
Dental-related emergency department (ED) visits are a growing public health concern. Dental insurance coverage is a strong predictor of dental service access. The objective of this study was to conduct a systematic review to assess the incidence of dental-related ED visits for Medicaid dental enrollees compared to those with other insurances.
METHODS
PubMed, EMBASE, and Google Scholar were searched for surveillance and observational data published in English from January 1999 to April 2020 to address the following PECOT question: Do patients with nontraumatic dental conditions (NTDC) (P1), or patients with any dental condition (P2) who have Medicaid (E) compared to other insurance status (private insurance, Medicare, no insurance) (C) have a differential incidence of single dental-related ED visits (O) in the literature search results from 1999 to April 2020 (T)? A critical appraisal was performed using a combination of the AXIS tool (for cross-sectional studies with observational data and MetaQAT (for public health evidence).
RESULTS
This systematic review included 32 studies. Overall, risk of bias was low. Due to significant statistical heterogeneity, a synthesis without meta-analysis was conducted. NTDC ED visits ranged from 16.0 percent to 79.8 percent for Medicaid patients and 0.9 percent to 57.2 percent for uninsured patients. The range for any dental visit to the ED was 2.2-63.8 percent for Medicaid patients and 2.9-40.8 percent for uninsured patients.
CONCLUSIONS
The results of this study support expanding insurance coverage in Medicaid programs to reduce ED use for NTDC visits in the United States.
目的
与其他保险相比，与牙齿相关的急诊（ED）就诊是日益严重的公共卫生问题。牙科保险覆盖范围是牙科服务获取的有力预测因素。本研究的目的是进行系统评价，以评估与其他保险相比，医疗补助牙科参保者因非创伤性牙科疾病（NTDC）就诊的 ED 就诊发生率。
方法
检索了 1999 年 1 月至 2020 年 4 月期间以英语发表的、来自 PubMed、EMBASE 和 Google Scholar 的监测和观察性数据，以解决以下 PECOT 问题：与其他保险状况（私人保险、医疗保险、无保险）相比，患有非创伤性牙科疾病（NTDC）（P1）或患有任何牙科疾病（P2）且拥有医疗补助（E）的患者（C）在 1999 年至 2020 年 4 月的文献检索结果中是否存在单次与牙齿相关的 ED 就诊（O）的差异发生率（T）？使用 AXIS 工具（用于具有观察性数据的横断面研究）和 MetaQAT（用于公共卫生证据）对评估进行了综合分析。
结果
本系统评价纳入了 32 项研究。总体而言，偏倚风险较低。由于存在显著的统计学异质性，因此未进行 meta 分析的综合分析。对于 Medicaid 患者，NTDC 的 ED 就诊率为 16.0%至 79.8%，而对于无保险患者，这一比例为 0.9%至 57.2%。任何牙科就诊到 ED 的比例， Medicaid 患者为 2.2%至 63.8%，无保险患者为 2.9%至 40.8%。
结论
本研究结果支持扩大 Medicaid 计划的保险覆盖范围，以减少美国因 NTDC 就诊而使用 ED 的情况。
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