259 - Socioeconomic Factor Effects on Antibiotics Prescribed in the Emergency Department

Socioeconomic Factor Effects on Antibiotics Prescribed in the Emergency Department
McConnaughhay M, Cawley M, Dirksen A, Larson L, Samson K, Steffen A, Lowman S
University of Nebraska Medical Center, Omaha, Ne

Purpose: Antibiotic Resistance is a major public health problem in the United States, resulting in significant morbidity and mortality. Antibiotic prescriptions for dental issues may contribute to this problem while providing only temporary relief of the underlying oral health condition. Previous research suggests differences in prescribing patterns for pain management by provider type, but little is known about antibiotic prescribing patterns, especially for diverse groups of pediatric patients. In addition, there is a gap in the literature regarding antibiotic stewardship instruction in dental education. This study aims to characterize antibiotic prescribing patterns in a midwestern Children's Hospital Emergency Department for non-traumatic dental conditions.

Methods: A chart review (n=1,094) was conducted of emergency department visits between 2013 and 2021 at Children’s Hospital and Medical Center in Omaha, NE for patients 19 years and younger presenting with non-traumatic dental conditions. Analysis is ongoing to determine the relationship between socioeconomic variables (insurance status, race, and ethnicity) and antibiotic prescription in the emergency department. We excluded patients from analysis who presented for dental trauma in order to focus on presentations surrounding dental infection. Also, analysis will differentiate between antibiotics prescribed according to current AAPD guidelines and those prescribed outside of the guidelines. Finally, we will describe prescribing by health care provider type (dentist, physician, and advanced practice professional). Descriptive statistics include frequencies, percentages, and confidence intervals.

Results: There was a significant association between insurance status and following guidelines (p = 0.04). Patients with private insurance had the lowest proportion of antibiotics prescribed outside of guidelines (6.0%) while patients on Medicaid had the highest (14.9%). There was also a significant association between race and following guidelines (p < 0.001). White patients had the lowest proportion of antibiotics prescribed outside of guidelines (5.7%) while African patients had the highest (27.3%).

Conclusion: Increased access to care for patients with low socioeconomic status involves an increase in primary care services (provided in a dental office) to avoid acute hospital care (in an emergency department).