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ERs: 'Cannot provide definitive dental treatment'

Rockville, Md.—Use of emergency departments for dental conditions may reflect system inefficiency in the delivery of dental care, the Agency for Healthcare Research and Quality said in health care quality and disparity reports.

The reports also note that although access to care "is getting worse for most groups," one of the few income-based disparities improving over time is dental visits by poor children compared with high income children ages 2-17.

Each year since 2003, the AHRQ has reported on progress and opportunities for improving health care quality and reducing health care disparities as mandated by the U.S. Congress. The 2012 reports, issued in May 2013, emphasize the need to accelerate progress toward optimal health care if the nation is to achieve higher quality and more equitable health care in the future, the agency said.

One approach to containing the growth of health care costs is to improve the efficiency of the health care delivery system, and one of the efficiency measurements in the reports is preventable emergency department visits, the reports said.

Both reports discuss emergency treatment for dental conditions. "Dental health requires periodic oral exams and timely treatment of tooth decay and gum disease. When patients do not access outpatient dental services, dental disease may progress and necessitate emergent treatment and even hospitalization. EDs cannot provide definitive dental treatment and can only provide medication for pain and infection. Hence, use of EDs for dental conditions may reflect system inefficiency in the delivery of dental care."

According to the reports (with supporting charts):

• In 2009, the rate of ED visits for dental conditions was 307 per 100,000 population.

• Males and females had similar rates of ED visits for dental conditions.

• Residents of the highest income quartile had lower rates of ED visits for dental conditions compared with residents of lower income quartiles.

• Children ages 0-17 and adults age 45 and over had lower rates of ED visits for dental conditions compared with adults ages 18-44.

• Residents of small metropolitan, micropolitan and noncore areas had higher rates of ED visits for dental conditions compared with residents of large metropolitan areas.

The AHRQ reports chart the 2009 rate of emergency department visits with a principal diagnosis related to dental issues per 100,000 population by age and residence location.

"Part of the discussion about how to improve efficiency involves the question about how best to measure it," the reports said. Preventable emergency department visits are among the efficiency measures presented.

The AHRQ reports also discuss trends in patient perceptions of need, including perceived difficulties or delays in obtaining care and problems getting care as soon as wanted. Among the findings:

• In 2009, 11.1 percent of people were unable to get or delayed in getting needed medical care, dental care or prescription medicines.

• In 2009, Asians (6.5 percent) and American Indians/Alaska Natives (8.1 percent) were less likely than Whites (11.6 percent) to report that they were unable to get or delayed in getting medical care, dental care or prescription medicines.

• In all years from 2002 to 2009, Hispanics were less likely than non-Hispanic Whites to report that they were unable to get or delayed in getting medical care, dental care or prescription medicines.

• In all years the percentage of people who were unable to get or delayed in getting needed medical care, dental care or prescription medicines was significantly higher for poor, low-income and middle-income people than for high-income people.

• In all years, people with less than a high school education and people with a high school education were more likely than those with any college education to report they were unable to get or delayed in getting needed care.

• In all years, people ages 18-44 were more likely than people age 65 and over and, in 7 of 8 years, people ages 0-17 to be unable to get or delayed in getting needed medical care, dental care or prescription medicines.

• Uninsured people and people with public insurance were more likely than people with private insurance to be unable to get or delayed in getting needed medical care, dental care or prescription medicines.

• In all years, uninsured people and people with public insurance were more likely than people with private insurance to be unable to get or delayed in getting needed medical care, dental care or prescription medicines. In 2009, for people under age 65, the percentage of people who were unable to get or delayed in getting needed medical care, dental care or prescription medicines was more than twice as high for people with no health insurance as for people with private insurance (20.3 percent compared with 8.7 percent).

Data sources include AHRQ's Healthcare Cost and Utilization Project Nationwide Emergency Department Sample, 2009, and Medical Expenditure Panel Survey, 2002-2009.