Medications Prescribed in Emergency Departments for Non-Traumatic Dental Conditio

描述（由申请人提供）：由于美国医疗和牙科保健费用的不断增加，决策者和卫生保健研究人员越来越关注使用急诊科（ED）提供初级保健服务。大多数患者以非创伤性牙齿状况（NTDC）和基于医学标准的非紧急医疗状况出现ED。在非结核性国家就诊时使用ED是一个日益严重的牙科公共卫生问题，需要紧急关注研究。非传染性疾病患者到急诊科就诊具有成本、实践和项目方面的影响，也是急诊科人满为患的潜在原因。然而，对于这些患者在急诊科接受非结核性疾病治疗的人群和治疗，我们了解得还不够。在牙科诊所治疗非传染性疾病最好是明确的，并且可以提供持续的护理。该项目的总体目标是解决非结核性疾病患者在急诊科就诊时与处方药相关的知识差距，并探讨处方实践中是否存在种族/民族差异。本研究的具体目的是：(1)估计1996 - 2006年非传染性疾病患者在急诊科就诊时使用处方药的情况和趋势。(2)确定患者因素、提供者类型、医院/急诊科和地理特征与1996年至2006年NTDC就诊的处方药收据相关。(3)根据医生诊断代码确定非结核性疾病中心就诊的处方药使用率，并具体评估患者的种族/民族对同一医生诊断代码获得类似处方的可能性的影响。拟议研究的数据库，1996-2006年全国医院门诊医疗调查（NHAMCS），是由国家卫生统计中心维护的持续运行时间最长的全国ED利用代表性调查。来自NHAMCS的数据提供了一套极其丰富的措施，包括关键患者人口统计、地理和医院/急诊科特征以及提供者信息。访问数据库提供了一个独特的机会，可以检查1996年至2006年到急诊科就诊的非结核性疾病患者的药物处方做法，以及是否存在差异。研究人群将包括数据库中的儿童和成人，该数据库由符合NTDC就诊标准的ED医疗保健提供者指定《国际疾病分类，第九次修订，临床修改》（ICD-9-CM）代码。将拟合逻辑回归模型来确定与其他协变量相关的结果变量。拟议研究的结果将作为制定数据驱动的方案和政策干预措施的起点，这些措施可用于改善获得牙科保健的机会，并减少口腔保健差距（如果存在的话）。研究结果将用于制定处方药治疗指南，以管理在不可避免的情况下到急诊科就诊的非传染性疾病患者。此外，该项目提供了在牙科学院内建立研究能力的机会，并为牙科和研究生提供了研究方法方面的培训，以备将来从事研究工作。

DESCRIPTION (provided by applicant): There is a growing attention paid by policymakers and health care researchers to the use of emergency departments (ED) for the provision of primary care services because of the continuous increase in medical and dental healthcare cost in the United States. Most patients present to ED with non-traumatic dental conditions (NTDC) and non-urgent medical conditions based on medical criteria. ED use for NTDC visits is a growing dental public health concern that requires urgent research attention. NTDC visits to ED have cost, practice, and program implications and is a potential reason for overcrowding at EDs. However, not enough is known about the population groups and treatments received by these patients at the ED for NTDC visits. NTDCs are best treated at dental offices were definitive and continuity of care can be provided. The overall goal of this project is to address the gap in knowledge related to prescription medications for NTDC visits at EDs and to explore whether racial/ethnic disparities exist in prescribing practices. The specific aims of this study are: (1) to estimate the prevalence and trend of prescription medication use for NTDC visits at EDs from 1996 to 2006. (2) to determine patient factors, provider types, hospital/ED, and geographic characteristics associated with the receipt of prescription medications for NTDC visits from 1996 to 2006. (3) to determine the rates of use of prescription medication for NTDC visits based on physician diagnosis codes, and to specifically evaluate the influence of patients' race/ethnicity on the likelihood of receiving similar prescription for the same physician diagnosis codes. The database for the proposed study, the 1996-2006 National Hospital Ambulatory Medical Care Survey (NHAMCS), is the longest continuously running nationally representative survey of ED utilization maintained by the National Center for Health Statistics. Data from NHAMCS provides an extremely rich set of measures on key patient demographics, geographic and hospital/ED characteristics, and provider Information. Access to the database provides a unique opportunity to examine medication prescription practices from 1996 to 2006 to patients presenting to ED for NTDC visits and whether disparities exists. The study population will include children and adults in the database with assigned International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code by ED healthcare providers that meet the criteria for NTDC visits. Logistic regression models will be fit to determine outcome variables associated with other covariates. The findings from the proposed study would serve as a starting point for the development of data-driven program and policy interventions that can be used to improve access to dental care and reduce oral health care disparities, if they exist. Findings from the study will be used to inform the development of prescription medication treatment guidelines for managing patients presenting to ED for NTDC visits in situation where it is unavoidable. In addition, the project provides the opportunity to build research capacity within the dental school and to train dental and graduate students in research methods for potential careers in research. PUBLIC HEALTH RELEVANCE: Identifying the different population groups and the medications prescribed for NTDC visits at EDs is important for dental public health programming. Dental public health professionals and stakeholders are able to use this information to development appropriate intervention strategies including the formulation of an appropriate national medication guideline for NTDC visits at EDs, where it is unavoidable.