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Schroeder S, Beck J, Medalen N, Stepanov A. Emergency Department and Dental Clinic Perceptions of Appropriate, and Preventable, Use of the ED for Non-Traumatic Dental Conditions in Hot-Spot Counties: A Mixed Methods Study. J Prim Care Community Health 2024; 15:21501319231222396. [PMID: 38185859 PMCID: PMC10773277 DOI: 10.1177/21501319231222396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVES Frequency of emergency department (ED) use for nontraumatic dental conditions (NTDC) is a well-researched community health concern. However, research predominately relies on ambulatory ED discharge records. This explanatory sequential mixed methods study reviewed NTDC ED use in hot-spot counties and assessed perceptions around preventable and appropriate use among EDs and dental clinics. METHODS Tooth pain data (2015-2021) were drawn from State Medicaid, and the Early Notification of Community-Based Epidemics (ESSENCE). NTDC data were compiled using International Classification of Disease, Ninth and Tenth Revisions. Employing extreme case sampling, providers in counties with the highest per-capita NTDC ED use were interviewed. RESULTS North Dakota experienced a decline in NTDC ED visits between 2017 and 2020, though the rate is now increasing. The greatest proportion of NTDC ED visits were among persons ages 20 to 34 and 35 to 44. ED and dental care staff have misconceptions around each other's roles in reducing NTDC ED visits, but unanimously suggest community-level prevention as a solution. CONCLUSIONS NTDC ED use was perceived as "appropriate" care. However, there is consensus that improved access to, and utilization of, affordable and quality preventative dental care would reduce NTDC ED visits and improve overall community health, especially among populations experiencing greater inequities.
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Affiliation(s)
| | - Judy Beck
- North Dakota Department of Health and Human Services, Bismarck, ND, USA
| | - Nikki Medalen
- Quality Health Associates of North Dakota, Minot, ND, USA
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da Motta TP, Owens J, Abreu LG, Debossan SAT, Vargas-Ferreira F, Vettore MV. Malocclusion characteristics amongst individuals with autism spectrum disorder: a systematic review and meta-analysis. BMC Oral Health 2022; 22:341. [PMID: 35948958 PMCID: PMC9367144 DOI: 10.1186/s12903-022-02366-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background To estimate the prevalence of malocclusion in individuals with autism spectrum disorders (ASD) and to assess the relationship between ASD and malocclusion.
Methods We searched electronic databases including PubMed, Scopus, Web of Science, Cochrane, Embase, SciELO LILACS, Proquest, OpenGrey and Google Scholar. There were no language or publication dates restrictions. Two researchers independently performed selection, data extraction and quality assessment. Quality assessment and risk of bias were evaluated through the Newcastle–Ottawa scale and ROBINS-E tool. Meta-analyses using random effect models were used to estimate pooled measures of prevalence of malocclusion characteristics in individuals with ASD and pooled odds ratio (OR) on the relationship between ASD and malocclusion characteristics. Subgroup meta-analyses were conducted according to children and adolescents, history of orthodontic treatment, and occurrence of other syndromes and medical conditions. Results Searching identified 5549 papers with 238 were selected for full assessment. Eighteen cross-sectional studies were included according to inclusion criteria. Of them, eleven studies were considered of moderate quality. A judgement of critical risk of bias occurred for thirteen studies. The most prevalent malocclusion characteristics in individuals with ASD were crowding (33%; 95% CI 22 to 44%) and increased maxillary overjet (39%; 95% CI 23 to 54%). Individuals with ASD had higher odds of Angle’s Class II (OR 1.92; 95% CI 1.36 to 2.72), Angle’s Class III (OR 2.33; 95% CI 1.29 to 4.23), open bite (OR 1.96; 95% CI 1.21 to 3.16), and increased maxillary overjet (OR 1.53; 95% CI 1.06 to 2.21) than individuals without ASD. Conclusions Angle’s Class II, Angle’s Class III, anterior open bite and increased maxillary overjet were more prevalent in individuals with ASD than those without ASD. Further high-quality studies are needed.
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Affiliation(s)
- Thiago Peixoto da Motta
- Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, CEP 312270-901, Brazil
| | - Janine Owens
- NIHR Applied Research Collaborative, Greater Manchester (NIHR ARC GM), Faculty of Biology, Medicine and Health, Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, CEP 312270-901, Brazil
| | - Suélen Alves Teixeira Debossan
- Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, CEP 312270-901, Brazil
| | - Fabiana Vargas-Ferreira
- Department of Social and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, CEP 312270-901, Brazil
| | - Mario Vianna Vettore
- Department of Health and Nursing Sciences, Faculty of Health and Sports Sciences, University of Agder, Campus Kristiansand, Universitetsveien 25, 4630, Kristiansand, Norway.
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Granja GL, Lacerda-Santos JT, Firmino RT, Jiao R, Martins CC, Granville-Garcia AF, Vargas-Ferreira F. Occurrence of bruxism in individuals with autism spectrum disorder: A systematic review and meta-analysis. SPECIAL CARE IN DENTISTRY 2022; 42:476-485. [PMID: 35263459 DOI: 10.1111/scd.12707] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/15/2022] [Accepted: 01/27/2022] [Indexed: 12/28/2022]
Abstract
AIMS To investigate bruxism in individuals with autism spectrum disorder (ASD) and neurotypical individuals. METHODS AND RESULTS Searches were conducted in the MedLine via Ovid, Embase via Ovid, Cochrane Database of Systematic Reviews, Scopus, Web of Science, Latin American and Caribbean Health Sciences (LILACS), Brazilian Library of Dentistry (BBO) and SciELO databases, grey literature and a hand search up to December 2020 with no restrictions imposed regarding language or year of publication (CRD42020211307). For the meta-analysis, the frequency of bruxism was extracted, with the calculation of odds ratios (OR) and 95% confidence intervals (CI) using a random effects model in RevManager. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Seventeen case-control studies were included in the qualitative synthesis and 15 were included in the meta-analysis, totaling a population of 3850 individuals. The ASD group was more likely to develop bruxism than the controls (OR: 3.80; 95% CI: 2.06-7.01). The certainty of the evidence was classified as "very low" for the occurrence of bruxism between ASD and control individuals. CONCLUSION It is uncertain whether individuals with ASD are more likely to have bruxism than healthy controls.
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Affiliation(s)
- Gélica L Granja
- Postgraduate Program in Dentistry, State University of Paraiba (UEPB), Campina Grande, Brazil.,Department of Dentistry, FIP Campina Grande, Campina Grande, Brazil
| | - Jhonatan Thiago Lacerda-Santos
- Postgraduate Program in Dentistry, State University of Paraiba (UEPB), Campina Grande, Brazil.,Department of Dentistry, FIP Campina Grande, Campina Grande, Brazil
| | - Ramon T Firmino
- Faculty of Medical Sciences of Campina Grande, UNIFACISA University Center (UNIFACISA), Campina Grande, Brazil.,Postgraduate Program in Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ruimin Jiao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Science, Beijing, China
| | - Carolina C Martins
- Dental School, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Gilmore D, Krantz M, Weaver L, Hand BN. Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:317-331. [PMID: 34881676 DOI: 10.1177/13623613211060906] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Autistic adults often have complex healthcare needs due to factors like having other health conditions, sensory sensitivities, and limited access to healthcare providers who are trained to provide care for them. All these factors may influence the healthcare services that autistic adults use. In this review, we searched six electronic research databases to gather the most recent evidence about how often autistic adults use five important healthcare services (the emergency department, hospitalization, outpatient mental health, preventive services, and primary care) compared to populations of non-autistic adults. A total of 16 articles were ultimately included in this review. Most articles found that autistic adults had equal or higher use of healthcare services than non-autistic adults. Autistic adults frequently used the emergency department and hospital. This may indicate that routine outpatient care in the community is not meeting their needs. Our findings show the importance of improving care at this level for autistic adults to reduce overuse of the emergency department (in this article referred to as ED) and hospital.
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Azimi S, Lima F, Slack-Smith L, Bourke J, Calache H, Junaid M, Leonard H. Factors associated with dental hospitalisations in children with intellectual disability or autism spectrum disorder: a Western Australian population-based retrospective cohort study. Disabil Rehabil 2021; 44:5495-5503. [PMID: 34148478 DOI: 10.1080/09638288.2021.1936662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study investigated dental hospitalisations in Western Australian (WA) children with intellectual disability (ID) and/or autism spectrum disorder (ASD) aged up to 18 years. METHODS Data on WA live births from 1983 to 2004 from the WA Midwives Notification System were linked to the Intellectual Disability Exploring Answers database, the WA Hospital Morbidity Data System, and the Western Australian Birth Defects Registry databases. Children were followed from birth to 2010 and the data grouped into three age-groups. Primary and secondary admissions for relevant dental diagnoses were identified and factors associated with having a dental hospitalisation investigated. RESULTS There were 1366, 1596, and 780 dental hospitalisations amongst 1122, 1154, and 609 children with ID and/or ASD in the 0-6, >6-12, and >12-18 year age groups, respectively. Children with severe ID were much more likely to be hospitalised than those with mild/moderate ID. More socioeconomically disadvantaged children were less likely to be hospitalised than children whose parents were socially advantaged. CONCLUSIONS There is concern that more vulnerable children in the WA community with ID or ASD are receiving an inadequate level of dental services compared with other groups resulting in potentially preventable hospitalisations, a situation in need of urgent remediation.Implications for rehabilitationLittle is known about why some children with intellectual disability (ID) or autism are being hospitalised for their dental care and others are not.Children with disability whose families are socioeconomically disadvantaged should have equivalent opportunity to receive optimal dental care.Dental practitioners at all levels need training and confidence in treating children with ID.
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Affiliation(s)
- Somayyeh Azimi
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,School of Human Sciences, University of Western Australia, Perth, Australia
| | - Fernando Lima
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Linda Slack-Smith
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Jenny Bourke
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Mohammed Junaid
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Perth, Australia
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Cothron A, Diep VK, Shah S, Brow A, Thakkar-Samtani M, Okunseri C, Tranby EP, Frantsve-Hawley J. A systematic review of dental-related emergency department among Medicaid beneficiaries. J Public Health Dent 2021; 81:280-289. [PMID: 34075587 DOI: 10.1111/jphd.12458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/11/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Dental-related emergency department (ED) visits are a growing public health concern. Dental insurance coverage is a strong predictor of dental service access. The objective of this study was to conduct a systematic review to assess the incidence of dental-related ED visits for Medicaid dental enrollees compared to those with other insurances. METHODS PubMed, EMBASE, and Google Scholar were searched for surveillance and observational data published in English from January 1999 to April 2020 to address the following PECOT question: Do patients with nontraumatic dental conditions (NTDC) (P1), or patients with any dental condition (P2) who have Medicaid (E) compared to other insurance status (private insurance, Medicare, no insurance) (C) have a differential incidence of single dental-related ED visits (O) in the literature search results from 1999 to April 2020 (T)? A critical appraisal was performed using a combination of the AXIS tool (for cross-sectional studies with observational data and MetaQAT (for public health evidence). RESULTS This systematic review included 32 studies. Overall, risk of bias was low. Due to significant statistical heterogeneity, a synthesis without meta-analysis was conducted. NTDC ED visits ranged from 16.0 percent to 79.8 percent for Medicaid patients and 0.9 percent to 57.2 percent for uninsured patients. The range for any dental visit to the ED was 2.2-63.8 percent for Medicaid patients and 2.9-40.8 percent for uninsured patients. CONCLUSIONS The results of this study support expanding insurance coverage in Medicaid programs to reduce ED use for NTDC visits in the United States.
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Affiliation(s)
| | - Vuong K Diep
- CareQuest Institute for Oral Health, Boston, MA, USA
| | | | - Avery Brow
- Chase Brexton Health Care, Baltimore, MD, USA
| | | | | | - Eric P Tranby
- CareQuest Institute for Oral Health, Boston, MA, USA
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Kisely S, Ogilvie J, Lalloo R. Avoidable emergency department presentations for dental comorbidities of psychiatric disorders: A population-based record-linkage analysis. J Psychosom Res 2021; 143:110387. [PMID: 33611073 DOI: 10.1016/j.jpsychores.2021.110387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Indigenous peoples and those from non-Caucasian, poorer or rural backgrounds are at greater risk of emergency department (ED) presentations for non-traumatic or avoidable dental conditions. There is no information on people with mental illness. OBJECTIVE To compare avoidable dental ED admissions in psychiatric patients with those of the general population over 2 years. METHODS A population-based record-linkage analysis across state-based facilities in Queensland, Australia. Avoidable dental ED presentations were defined using ICD10 codes K02.9, K04.7, K05.0, K08.8 and K12. RESULTS There were 1,381,428 individuals in the linked database, of whom 657,933 (47.6%) were male. Of the sample, 177,157 (13%) had a history of contact for mental health problems and 22,046 (1.5%) had at least one avoidable dental presentation. The most two common were unspecified disorders of teeth or supportive structures (n = 10,184) and periapical abscesses (n = 7970). After adjusting for confounders, those who had ever needed psychiatric treatment were 72% more likely to experience an avoidable dental presentation (95% = 1.65-1.79; p < 0.0001). Other significant independent risk factors were lower income, rurality and Indigenous status. Within the inpatient psychiatric group, those with substance use or personality disorders had the highest risk of avoidable presentations. CONCLUSIONS In common with other marginalised groups, psychiatric patients have increased avoidable presentations. Possible clinical interventions could include an increased emphasis on oral health assessment in primary health care and early dental referral. Dental education and service planning should consider this population's needs including easier navigation of services, availability outside normal office hours, and free outreach dental clinics.
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Affiliation(s)
- Steve Kisely
- School of Medicine, The University of Queensland, Woolloongabba, QLD, Australia; Addiction and Mental Health Services, Metro South Health, Woolloongabba, QLD, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada.
| | - James Ogilvie
- Griffith Criminology Institute, Griffith University, QLD, Australia
| | - Ratilal Lalloo
- School of Dentistry, The University of Queensland, Herston, QLD, Australia
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Akinlotan MA, Ferdinand AO. Emergency department visits for nontraumatic dental conditions: a systematic literature review. J Public Health Dent 2020; 80:313-326. [DOI: 10.1111/jphd.12386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/24/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Marvellous A. Akinlotan
- Department of Health Policy and Management Texas A&M School of Public Health College Station TX USA
| | - Alva O. Ferdinand
- Department of Health Policy and Management Texas A&M School of Public Health College Station TX USA
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Frichembruder K, Mello dos Santos C, Neves Hugo F. Dental emergency: Scoping review. PLoS One 2020; 15:e0222248. [PMID: 32058998 PMCID: PMC7063673 DOI: 10.1371/journal.pone.0222248] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/23/2020] [Indexed: 11/22/2022] Open
Abstract
Part of the oral health care in the care network encompasses users in emergency cases. This study proposed mapping the determinants of the use of dental care services within the health care network to address dental emergencies within the Brazilian Unified Health System (UHS) and to verify the main gaps in the research in this area. This is a scoping review that took place in 2018 using Andersen's behavioral model as a reference. A total of 16 studies, out of 3786 original articles identified, were included and reviewed. Two reviewers independently conducted the selection process and the decision was consensually made. The mapping of the determinants revealed a greater number of enabling factors and a larger gap in the results. Greater use of the emergency service was registered by people in pain, women, adults, those from an urban area, people with a lower income, and those with less education. In future studies, primary surveys are recommended, which include all ages, and analyze different groups of needs and users that take into account the country's northern region and the different subjects pointed out by this review.
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Affiliation(s)
- Karla Frichembruder
- Center of Social Dentistry Research, Federal University of Rio Grande do
Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Camila Mello dos Santos
- Center of Social Dentistry Research, Federal University of Rio Grande do
Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Collective Health, Federal University of Rio Grande
do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernando Neves Hugo
- Graduate Program in Dentistry, Federal University of Rio Grande do Sul,
Porto Alegre, RS, Brazil
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Abdelrahim A, Shimpi N, Hegde H, Kleutsch KC, Chyou PH, Jain G, Acharya A. Feasibility of establishing tele-dental approach to non-traumatic dental emergencies in medical settings. AMERICAN JOURNAL OF DENTISTRY 2020; 33:48-52. [PMID: 32056416 PMCID: PMC7354845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Non-traumatic dental condition visits (NTDCs) represent about 1.4% to 2% of all Emergency Department (ED) visits and are limited to palliative care only, while associated with high cost of care. Feasibility of establishing a tele-dental approach to manage NTDCs in ED and Urgent care (UC) settings was undertaken to explore the possibility of utilizing remote tele-dental consults. METHODS Participants with NTDCs in ED/UCs were examined extra and intra-orally: (1) directly by ED provider, (2) remotely by tele-dental examiner (trained dentist) using intra-oral camera and high-definition pan-tilt-zoom (PTZ) camera, (3) directly by treating dentist post ED/UC visit (if applicable) and, (4) secondary assessment by tele-dental reviewer. Comparisons were drawn between differential diagnoses and recommended managements provided by ED/UC providers, tele-dental examiner, treating dentist, and tele-dental reviewer. RESULTS 13 patients participated in the study. The overall inter-rater agreement between the tele-dental examiner and tele-dental reviewer was high while it was low between tele-dentists and the ED providers. The preliminary testing of tele-dental intervention in the ED/UC setting demonstrated potential feasibility in addressing the NTDC landing in ED/UC. Larger interventional studies in multi-site setting are needed to validate this approach and especially evaluate impact on cost, ED/UC workflow and patient outcomes. CLINICAL SIGNIFICANCE Using tele-dentistry to triage non-traumatic dental visits to the emergency room may be a promising approach. Once this approach is validated through a larger study, tele-dental outreach could help in directing non-traumatic dental emergency patients to the appropriate dental setting to provide treatment for the patients.
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Affiliation(s)
- Adham Abdelrahim
- Post-doctoral fellow, Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
- Computational and Informatics in Biology and Medicine program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Neel Shimpi
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Harshad Hegde
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Katelyn C Kleutsch
- Dental student, Arizona School of Dentistry & Oral Health, A.T. Still University, Arizona, USA
| | - Po-Huang Chyou
- Office of Computing and Analytics, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Gaurav Jain
- Medford Dental Center, Family Health Center, Inc., Medford, Wisconsin, USA
| | - Amit Acharya
- Marshfield Clinic Research Institute and Scientist, Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA,
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See-Hear-Feel-Speak: A Protocol for Improving Outcomes in Emergency Department Interactions With Patients With Autism Spectrum Disorder. Pediatr Emerg Care 2019; 35:157-159. [PMID: 30702545 DOI: 10.1097/pec.0000000000001734] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The presentation of children and adolescents with autism in the emergency department (ED) poses a unique set of challenges to clinicians and their teams, which have not yet been met. Children and adolescents with autism spectrum disorder (ASD) are more likely than their age and ethnically matched counterparts to visit both pediatric and general EDs and are more likely to use it for primary care complaints and dental care and to present for psychiatric concerns including suicidality. Despite the higher relative frequency, individuals with ASD demonstrate lower patient satisfaction, lower healthcare self-efficacy, and higher odds of unmet healthcare needs related to physical health, mental health, health maintenance, and vaccination. This can be ameliorated by simple strategies regarding communication, sensory and environmental modification, and distraction. After performing a literature review of existing evidence-based recommendations via PubMed as well as resources from autism advocacy and self-advocacy groups, we compiled a 4-step system: "See-Hear-Feel-Speak" an approach conducive to learning with the goal of enabling clinicians and their teams to facilitate patient-centered encounters with pediatric patients with ASD. The protocol meets the practicality requirements defined by published research.
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Chi DL, Momany ET, Mancl LA, Lindgren SD, Zinner SH, Steinman KJ. Dental Homes for Children With Autism: A Longitudinal Analysis of Iowa Medicaid's I-Smile Program. Am J Prev Med 2016; 50:609-615. [PMID: 26514624 PMCID: PMC4838561 DOI: 10.1016/j.amepre.2015.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/05/2015] [Accepted: 08/25/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Medicaid-enrolled children with autism spectrum disorder (ASD) encounter significant barriers to dental care. Iowa's I-Smile Program was implemented in 2006 to improve dental use for all children in Medicaid. This study compared dental home and preventive dental utilization rates for Medicaid-enrolled children by ASD status and within three time periods (pre-implementation, initial implementation, maturation) and determined I-Smile's longitudinal influence on ASD-related dental use disparities. METHODS Data from 2002-2011 were analyzed for newly Medicaid-enrolled children aged 3-17 years (N=30,059); identified each child's ASD status; and assessed whether the child had a dental home or utilized preventive dental care. Log-linear regression models were used to generate rate ratios. Analyses were conducted in 2015. RESULTS In 2003-2011, 9.8% of children with ASD had dental homes compared with 8% of children without ASD; 36.3% of children with ASD utilized preventive care compared to 45.7% of children without ASD. There were no significant differences in dental home rates by ASD status during pre-implementation, initial implementation, or maturation. There were no significant differences in preventive dental utilization by ASD status during pre-implementation or initial implementation, but children with ASD were significantly less likely to utilize preventive care during maturation (rate ratio=0.79, p<0.001). Longitudinal trends in dental home and preventive dental utilization rates were not significant (p=0.54 and p=0.71, respectively). CONCLUSIONS Among newly Medicaid-enrolled children in Iowa's I-Smile Program, those with ASDs were not less likely than those without ASD to have dental homes but were significantly less likely to utilize preventive dental care.
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Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington, Seattle, Washington.
| | | | - Lloyd A Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | | | - Samuel H Zinner
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Kyle J Steinman
- Department of Neurology, University of Washington, and Seattle Children's Research Institute, Seattle, Washington
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