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Joshua D. Stein, Nidhi Talwar, Paul P. Lee; Utilization of the Emergency Department Services for Non-Urgent Ophthalmologic Conditions. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1436.
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Emergency department (ED) visits for nonurgent ophthalmic conditions that could be managed in other settings may provide an appropriate opportunity to reduce the costs of care. To do so, it is important to better understand patient characteristics associated with ED utilization for nonurgent ophthalmic conditions.
Records of all ED visits in 2001-2009 for any ophthalmologic reason were reviewed for enrollees aged ≥21 in a managed-care network. To be conservative, visits were categorized as nonurgent if the diagnosis was conjunctivitis, chalazion, or blepharitis with no other ocular or nonocular condition. Multivariable Cox regression was conducted to assess the characteristics of patients using the ED for nonurgent eye care.
Among the 107568 patients with ≥1 ED visit for any ophthalmologic issue, 25009 (23.2%) had a nonurgent condition. The likelihood of using ED resources for nonurgent ophthalmic conditions was increased by 52% for blacks (adjusted HR=1.52 [95% CI=1.30-1.77]) and 22% for Latinos (HR=1.22 [CI=1.05-1.42]), compared with whites. Patients with net worth >$25 000 had a reduced likelihood (P≤.004) of such visits, as did older patients (P<.001). Enrollment in a Medicaid or Medicare managed-care plan was associated with an 87%-increased hazard (HR=1.87 [CI=1.45-2.41]) and 36%-increased hazard (HR=1.36 [CI=1.08-1.72]), respectively, for nonurgent eye-related ED visits, compared with enrollment in a commercial plan. Nonurgent eye-related visits were significantly less likely among rural residents than urban residents (P≤.02) but significantly more likely among residents of Western states than among North-Eastern residents (P<0.001). Frequent ED use (≥3 visits/yr) for non-eye-related conditions was associated with a 405%-increased hazard for a nonurgent ophthalmologic-related visit (HR=5.05 [CI=4.21-6.04]).
Many ED visits for ophthalmic conditions involve nonurgent care, which could be delivered in an office setting. By identifying individuals who seek care in the ED for nonurgent eye conditions and addressing the reasons for care in an ED rather than other settings, health policy-makers can help direct care to more appropriate and cost-effective settings.
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