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.
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.
| Okunseri, Christopher; Okunseri, Elaye; Xiang, Qun et al. (2014) Prescription of opioid and nonopioid analgesics for dental care in emergency departments: Findings from the National Hospital Ambulatory Medical Care Survey. J Public Health Dent 74:283-92 |
| Pajewski, Nicholas M; Okunseri, Christopher (2014) Patterns of dental service utilization following nontraumatic dental condition visits to the emergency department in Wisconsin Medicaid. J Public Health Dent 74:34-41 |
| Okunseri, Christopher; Okunseri, Elaye; Chilmaza, Cesar A et al. (2013) Racial and ethnic variations in waiting times for emergency department visits related to nontraumatic dental conditions in the United States. J Am Dent Assoc 144:828-36 |
| Okunseri, Christopher; Okunseri, Elaye; Thorpe, Joshua M et al. (2012) Medications prescribed in emergency departments for nontraumatic dental condition visits in the United States. Med Care 50:508-12 |
