Emergency department presentation for uncomplicated acute rhinosinusitis is associated with poor access to healthcare

Abstract

Objectives/Hypothesis Uncomplicated acute rhinosinusitis (ARS) is most appropriately managed in an outpatient clinic setting. Some ARS patients present to emergency departments (EDs) for care. We investigates factors associated with ARS presentation to EDs versus outpatient settings. Study Design Cross‐sectional study. Methods A total of 17,122,551 pediatric and adult patient visits from the 2009 and 2010 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Surveys for ARS were identified. Patients with ARS complications were excluded. Univariate and multivariate associations identified demographic and socioeconomic characteristics of ARS patients independently associated with ED presentation. Temperature >100°F was used as a proxy for ARS severity. Results Patients with Medicaid (odds ratio [OR] = 10.82, P < .001) or no insurance (OR = 9.14, P < .001) more likely presented to EDs when compared to patients with private insurance or Medicare. Independently, black patients (OR = 6.01, P < .001) more likely presented to EDs when compared to white or Hispanic patients. No significant association was seen with metropolitan or socioeconomic status based upon the patients' home zip code. Conclusions Presentation of ARS patients to EDs is associated with health insurance type and patient race independent of socioeconomic status. Healthcare access appears to be a primary determinant of whether patients present to an ED or outpatient setting for this common health problem. The association between race and ED presentation suggests cultural underpinnings requiring further characterization. Reducing barriers to care, for example through broader health insurance coverage, may enhance access to outpatient care providers and decrease costs associated with unnecessary ED presentation. Level of Evidence 4. Laryngoscope, 125:2253–2258, 2015

Socioeconomic determinants of overnight and weekend emergency department use for acute rhinosinusitis

“…We have previously characterized factors associated with ED presentation for uncomplicated ARS and found an association with insurance status . Specifically, Medicaid and self‐pay insurance statuses were associated with ED presentation for uncomplicated ARS, suggesting healthcare access may be one factor driving ED utilization for this disease.…”

“…The need for urgent evaluation is rare, and most uncomplicated ARS can be treated conservatively with observation or a brief course of antibiotics. Despite this typically benign nature, approximately 500,000 patients with ARS present to EDs for evaluation annually, leading to a considerable economic impact on healthcare expenditures …”

Emergency department use for acute rhinosinusitis: Insurance dependent for children and adults

“…Overall, 93.5% of uncomplicated ARS visits were to a PCP, and 6.5% of visits were to the ED. These percentages are comparable to those reported in our prior work, in which 94.2% of visits were to a PCP and 5.8% were to an ED . Seven percent of adult visits versus 4.8% of pediatric visits were to an ED.…”

“…Concerns exist regarding problems with access to care and quality of care for not only the uninsured but also patients with Medicaid . We previously have found that for uncomplicated acute rhinosinusitis (ARS)—a common condition with more than 20 million cases annually in the United States—patients with Medicaid or self‐pay insurance status disproportionately are more likely to present to an emergency department (ED) for ARS versus privately insured patients . Children and adults suffering from ARS may seek care at an ED or primary care provider (PCP); in both cases, over 50% of adult and pediatric ARS patients receive an antibiotic independent of insurance status .…”

Treatment disparities in the management of epistaxis in United States emergency departments

“…It has been demonstrated that social and racial disparities may negatively influence healthcare decision making in the ED setting . Several studies have now elucidated socioeconomic disparities in otolaryngology ED care, including utilization of computed tomography scans and presentation to the ED for acute rhinosinusitis …”