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Emergency department use for acute rhinosinusitis: Insurance dependent for children and adults
Regan W Bergmark1,2, Stacey L Ishman3,4,5, Katie M Phillips1,2
1Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
Insights
Patients with Medicaid or self-pay insurance are more likely to visit the emergency department for acute rhinosinusitis (ARS). This pattern is consistent for both pediatric and adult visits, indicating potential primary care access issues.
Area of Science:
- Otolaryngology
- Health Services Research
- Public Health
Background:
- Uncomplicated acute rhinosinusitis (ARS) is a common condition.
- Previous studies suggest insurance status influences healthcare seeking behavior.
Purpose of the Study:
- To investigate if insurance status (Medicaid, self-pay) affects emergency department (ED) versus primary care physician (PCP) utilization for uncomplicated ARS.
- To determine if this association differs between pediatric and adult patients.
Main Methods:
- Cross-sectional study utilizing 2005-2012 National Hospital Ambulatory Medical Care Surveys.
- Included visits coded for ARS without complications.
- Logistic regression analysis controlled for clinical and demographic factors, stratifying by age group.
Main Results:
- Medicaid insurance was significantly associated with ED presentation for ARS in both children (aOR=7.0) and adults (aOR=6.8).
- Self-pay status showed a much stronger association with ED visits for children (aOR=48.8) compared to adults (aOR=5.2).
- Overall, Medicaid and uninsured patients had fewer ARS visits compared to privately insured individuals.
Conclusions:
- Insurance status, particularly Medicaid and self-pay, is strongly linked to emergency department use for uncomplicated ARS in both children and adults.
- Children with self-pay insurance are disproportionately more likely to use the ED for ARS.
- Findings suggest disparities in primary care access for uncomplicated ARS, especially for uninsured pediatric patients.
Objectives/Hypothesis:
Patients with Medicaid or self-pay insurance status are more likely to present to the emergency department (ED) for uncomplicated acute rhinosinusitis (ARS). Our aim was to determine if this pattern holds true for both pediatric and adult visits.
Study Design:
Cross-sectional study using the 2005 to 2012 National Hospital Ambulatory Medical Care Surveys and National Ambulatory Medical Care Surveys.
Methods:
We included all visits with International Classification of Diseases, Ninth Revision codes for ARS and without codes for ARS complications. We tested for associations between insurance type and presentation to an ED versus a primary care physician (PCP), stratifying children versus adults. We used univariate and multivariable logistic regression modeling, controlling for clinical and demographic characteristics for analysis.
Results:
There were 51,579,977 uncomplicated ARS visits to PCPs (48,213,335 visits) and EDs (3,366,642 visits). Medicaid and uninsured patients were under-represented for ARS visits. Medicaid insurance was significantly associated with ED presentation for ARS for both children (adjusted odds ratio [OR] = 7.0, P < 0.001) and adults (adjusted OR = 6.8, P < 0.001). Children with ARS and self-pay insurance status were much more likely to present to the ED (adjusted OR = 48.8, P < 0.001) than adults (adjusted OR = 5.2, P < 0.001); this difference between children and adults with self-pay insurance was significant (P = 0.001).
Conclusion:
With respect to absolute numbers of visits, patients with Medicaid or no insurance use less care overall for uncomplicated ARS than do privately insured patients. Medicaid is associated with ED presentation for ARS for pediatric and adult visits. Self-pay insurance status is strongly associated with ED presentation for adult and pediatric visits, and is significantly more common for children. These results suggest limitations in primary care access for uncomplicated ARS based on insurance status, particularly for uninsured pediatric patients.
Level Of Evidence:
4. Laryngoscope, 128:299-303, 2018.
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