Emergency Department Visits for Nontraumatic Dental Problems: A Mixed-Methods Study
Emergency Department Visits for Nontraumatic Dental Problems: A Mixed-Methods Study
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DOI：
10.2105/ajph.2014.302398
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发表时间：
2015-05-01
影响因子：
12.7
通讯作者：
Lowe, Robert A.
中科院分区：
文献类型：
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作者：
Sun, Benjamin C.;Chi, Donald L.;Lowe, Robert A.
目标.我们记录了急诊科（艾德）就诊的非创伤性牙齿问题，并确定了减少艾德牙科就诊的策略。我们使用混合方法分析了2010年俄勒冈州25家医院的索赔和俄勒冈州的所有付款人所有索赔数据集的有目的样本，并采访了来自6个社区的51名艾德牙科访问者和利益相关者。牙科就诊占艾德就诊的2.5%，是20至39岁成年人中第二常见的出院诊断，与未投保有关（比值比[OR] = 5.2 [参考：商业保险]; 95%置信区间[CI] = 4.8，5.5）或有医疗补助保险（OR = 4.0; 95% CI = 3.7，4.2），导致阿片类药物（56%）和抗生素（56%）处方，每次就诊产生402美元（95% CI = 396美元，408美元）的住院费用。访谈显示卫生系统，社区，供应商和患者贡献者艾德牙科就诊。受访者提供的潜在解决方案包括医疗补助福利扩大，护理协调，水氟化和病人教育。急诊牙科就诊对于弱势群体来说是一个重要且昂贵的公共卫生问题。未来的努力应集中在实施多层次干预措施上，以减少艾德牙科就诊。
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.