Wisconsin Medicaid enrollees’ recurrent use of emergency departments and physicians’ offices for treatment of nontraumatic dental conditions

• Published in: The Journal of the American Dental Association (1939) Vol. 142; no. 5; pp. 540 - 550
• Main Authors: Okunseri, Christopher, BDS, MSc, DDPHRCSE, FFDRCSI, Pajewski, Nicholas M., PhD, Jackson, Scott, MS, Szabo, Aniko, PhD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.05.2011; American Dental Association
• Subjects: Adolescent; Adult; African Americans - statistics & numerical data; Age Factors; Child; Dental care; Dental Care - statistics & numerical data; Dentistry; Dentists - statistics & numerical data; DHPSA: Dental health professional shortage area; ED: Emergency department; emergency department; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; European Continental Ancestry Group - statistics & numerical data; Female; Hispanic Americans - statistics & numerical data; Humans; ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modifications; Male; Medicaid; Medicaid - statistics & numerical data; Medically Underserved Area; Middle Aged; Mouth Diseases - therapy; nontraumatic dental conditions; NTDC: Non-traumatic dental condition; Patients rights; Periodontal Diseases - therapy; Physicians' Offices - statistics & numerical data; physicians’ offices; PO: Physician’s office; Poverty - statistics & numerical data; Retrospective Studies; Rural Health - statistics & numerical data; Sex Factors; Tooth Diseases - therapy; UIC: Urban influence code; United States; Urban Health - statistics & numerical data; Wisconsin; Young Adult; United States; Wisconsin; physicians’ offices; DHPSA: Dental health professional shortage area; UIC: Urban influence code; ED: Emergency department; ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modifications; nontraumatic dental conditions; PO: Physician’s office; Medicaid; emergency department; NTDC: Non-traumatic dental condition
• ISSN: 0002-8177; 1943-4723
• DOI: 10.14219/jada.archive.2011.0224

ABSTRACT Background Medicaid enrollees experience a number of barriers that prevent them from seeking care in dental offices, leading some to repeatedly seek treatment for nontraumatic dental conditions (NTDCs) in emergency departments (EDs) and physicians’ offices (POs). The authors examined the rate of return visits to EDs and POs for treatment of NTDCs among Wisconsin Medicaid enrollees and sought to characterize frequent and typical users of such care in this population. Methods The authors conducted a retrospective analysis of all Wisconsin Medicaid dental claims for NTDCs to EDs and POs from 2001 through 2003. They used finite mixture models, allowing for covariate dependence, to model separate rates of return for NTDC-related visits corresponding to typical and frequent users of EDs and POs. Results Overall, 23,999 enrollees had made NTDC-related visits to EDs and POs, with 6.5 percent estimated to be frequent users of such care. Typical and frequent users had a mean (± standard error) rate of return visits of 0.2 ± 0.01 and 4.0 ± 0.08 per year, respectively. Male enrollees and people aged 19 to 42 years were more likely to be frequent users, with African American and Hispanic enrollees having lower odds of being frequent users than did white enrollees. The effect of living in an area with a shortage of dental health care professionals did not affect the likelihood of being a frequent user of EDs and POs for such care. Conclusions Male and middle-aged enrollees were significantly more likely to be frequent users of EDs and POs for treatment of NTDCs. Compared with white enrollees, African American and Hispanic enrollees were less likely to be frequent users and had lower rates of recurrent visits for NTDCs among typical users. Clinical Implications Improved access to dental care for Medicaid enrollees that is best managed by dental care providers should reduce the rates of recurrent NTDC-related visits to EDs and POs.