Avoidable emergency department visits: a starting point

Hsia, Renee Y.; Niedzwiecki, Matthew J.

doi:10.1093/intqhc/mzx081

Cited by 63 publications

(75 citation statements)

References 10 publications

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“…In contrast, we cannot rule out the inappropriate utilization of ED for routine and primary care treatable reasons . Issues of quality and timely access to primary care and coordination among providers for such patients are raised.…”

Section: Discussionmentioning

confidence: 77%

Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review

Giannouchos

Kum

Foster

et al. 2019

Evaluation Clinical Practice

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Study objective:We conducted a systematic literature review to identify and to update patient characteristics and contextual factors for adult frequent emergency department users (FEDUs) compared with non-FEDU in an era where the US health care system underwent substantial changes. Methods:We searched MEDLINE, CINAHL, and EMBASE to identify all relevant articles after 2010 through July 2018 that describe FEDU. We included US studies on adult FEDU only and excluded studies on specific subgroups of FEDU. We included demographic, clinical, and health care utilization information, and two reviewers independently evaluated the studies using the Joanna Briggs Institute Critical Appraisal tool. Results:The 11 studies included in the review indicated that FEDU were 4% to 16% of total ED users but accounted for 14% to 47% of ED visits, with six to nine visits per year on average. The majority of FEDU were young or middle-aged adults, females, of low socioeconomic status and high school or less education, with public insurance, multiple primary care provider visits, and chronic conditions. Fair or poor self-perceived health status, unemployment, unmet needs from primary care providers (PCPs), mental health, and substance abuse were predictors of FEDU. Conclusion:FEDUs are disproportionally sicker and are also heavy users of non-ED health care service providers. The limited data for non-ED health services use in facility-specific studies of FEDU may contribute to findings in such studies that complex and unmet needs from PCPs contributed to ED visits. This suggests the need for more comprehensive data analysis beyond a few sites that can inform systemic management approaches.

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Section: Discussionmentioning

confidence: 77%

Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review

Giannouchos

Kum

Foster

et al. 2019

Evaluation Clinical Practice

View full text Add to dashboard Cite

show abstract

“…Only 1 other study has examined the association between OHL and emergency NTDC visits (conducted in a sample of Brazilian adults), and our findings are similar to theirs, which relied on self‐reported dental emergency visits. Emergency visits for NTDCs are a considerable burden on health care costs in many areas of the United States . In concert with underutilized primary/preventive dental care, the degree to which OHL may causally influence inappropriate acute dental care decisions over time should be further explored.…”

Section: Discussionmentioning

confidence: 99%

Oral Health Literacy and Outcomes in Rural Wisconsin Adults

VanWormer

Tambe

Acharya

2018

The Journal of Rural Health

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Purpose Low oral health literacy (OHL) is an emerging risk factor for several oral health outcomes, but there are very few studies of OHL overall and no studies of OHL in the rural United States. The purpose of this study was to examine the association between OHL and sociodemographic factors, as well as several oral health outcomes, in rural adults served by an integrated medical and dental care system in Wisconsin. Methods A cross‐sectional survey was administered to a stratified random sample of patients from 2 rural communities. Survey data were linked to local electronic health records. Multivariable regression was used to identify sociodemographic determinants of low OHL, as well as associations between OHL and: oral hygiene, oral health quality of life, dentist visits, and emergency/urgent care visits for nontraumatic dental conditions. Findings Among the 164 respondents, OHL scores were generally high but were significantly lower among nonwhite participants (P < .001), as well as those without a college degree (P < .001) and those with an annual household income under $40,000 (P = .029). Lower OHL scores were significantly associated with lower quality of life scores (P = .005), fewer visits to the dentist (P = .007), and more emergency room visits for nontraumatic dental conditions (P = .021). Conclusion In rural Wisconsin, low OHL tracked closely with markers of socioeconomic status and appeared most influential in the context of appropriate dental care utilization. Future research should consider longitudinal explorations of how OHL influences preventive and emergency dental visits over time.

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“…In fact, one recent study examining 424 million ED visits suggested that as many as 3.3% ED visits (14,123,939 visits) did not require any diagnostic or screening services, procedures or medications, and were discharged home -and the top three ICD-9 diagnoses associated with these visits included dental disorders (along with alcohol abuse and depressive disorders). [3] While it has long been recognized that there are opportunities to improve antibiotic prescribing for many common diagnoses in outpatient settings, including the ED, one potentially overlooked area for improvement is dental conditions. [1,4] There has been increased attention focused on understanding and improving antibiotic prescribing by dentists in recent years; including reporting the most commonly prescribed antibiotics and characteristics of patients receiving them.…”

Section: Background and Introductionmentioning

confidence: 99%

Antibiotic Prescriptions Associated With Dental-Related Emergency Department Visits

Roberts

Hersh

Shapiro

et al. 2019

Annals of Emergency Medicine

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Antibiotic prescribing for dental conditions in the emergency department (ED), is poorly understood. The objective of this study was to quantify how often and which dental diagnoses seen in the ED resulted in an antibiotic prescription. From 2010-2015, there were 2.2 million ED visits per year for dental-related conditions, which accounted for 1.6% of ED visits. An antibiotic, most often a narrow-spectrum penicillin or clindamycin, was prescribed in 65% of ED visits with any dental diagnosis. The most common dental diagnoses seen in the ED for all ages were unspecified disorder of the teeth and supporting structures (44%, ICD-9-CM code 525.9), periapical abscess without sinus (21%, ICD-9-CM code 522.5) and dental caries (18%, ICD-9-CM code 521.0).

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Avoidable emergency department visits: a starting point

Cited by 63 publications

References 10 publications

Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review

Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review

Oral Health Literacy and Outcomes in Rural Wisconsin Adults

Antibiotic Prescriptions Associated With Dental-Related Emergency Department Visits

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