Frequent Users of Emergency Departments and Physician Offices for Non Traumatic Dental Conditions among Wisconsin Medicaid Enrollees

Objective: Medicaid enrollees experience a number of barriers that prevent them from seeking care in dental offices; instead some continually seek treatment for non traumatic dental conditions (NTDC) in emergency departments (ED) and physician offices (PO). This study characterizes frequent users and examined the rate of return visits to ED/PO for NTDC among Wisconsin Medicaid enrollees.

Methods: Medicaid claims for NTDC visits in Wisconsin from 2001- 2003 were analyzed. A mixture of two Poisson distributions with different visit rates (normal and heavy users) was fitted. The effect of covariates on the probability of being a heavy user was modeled by a logistic link and the effect on the rate of additional visits among normal users was modeled by a log link.

Results: Overall, 41,046 patients were evaluated, 23,999 had NTDC visits to ED/PO, and 6.7% were estimated to be heavy users. Heavy and normal users had recurrent visit rates of 3.95±0.02 and 0.27±0.03 per year, respectively. Compared to whites, Native Americans, males, aged 25-45, and micropolitan residents were more likely to be heavy users, Hispanic and African-American were less likely to be heavy users. Among normal users, those aged 25-45 had the highest rate of recurrent use, African-Americans, males, and micropolitan residents had lower rates.

Conclusions: Native Americans, males aged 25-45 years, and micropolitan counties residents were significantly more likely to be heavy users of ED/PO for NTDC. Improved access to care for Medicaid enrollees might reduce the cost associated with recurrent ED/PO visits for NTDC.