Effectiveness of Three Dental Emergencies Services of Hospitals in Santiago, Chile

Abstract

Objectives: To compare the effectiveness and patient satisfaction of dental emergencies services of three hospitals in Santiago, Chile. Methods: A pre-post design was employed. Participants were asked to complete pre- (in-person) and post- (by telephone) surveys. The pre-visit surveys included demographic data, patient’s self-reported pain level, and oral health-related quality of life. Self-reported pain level was measured using a Visual Analogue Scale (VAS) and oral health quality of life was measured using the Dental Health Status Quality of Life Questionnaire (DS-QoL); higher values indicated greater pain and lower quality of life. VAS and DS-QoL were measured before and approximately one week after the dental visit. Statistical analysis was performed to test if there was a difference between the effectiveness of the dental emergency services among hospitals using change in the level of pain (VAS scores) and quality of life (DS-QoL) scores. 1.3 Results A total of 601 patients were interviewed. The average age was 38 years (range 18-85 years) and 57% were females. Across all three hospitals, the most prevalent reason for using dental emergency services was pain (79%). The main diagnoses were periodontal conditions (39%), pulp and periapical lesions (28%), and disorders of tooth eruption (11%). The main treatments given were tooth extraction (71%), antibiotic prescription (12.5%) and other prescriptions (9%). Eighty percent (n=481) were interviewed at follow-up 7 to 10 days after the initial visit. The median pain scores for pain preceding and following dental care were 70 and 0, respectively. The median quality of life (Ds-QoL) scores preceding and following dental care were 15 and 7, respectively. In univariate analyses, the only factor associated with variation in pain was the patient’s chief complaint. In multivariate analyses, chief complaint and hospital were independent predictors of variation on quality of life score. The median for overall satisfaction was 6, with a maximum of 7. Patient satisfaction was comprised of the median for Interpersonal satisfaction was 30, with a maximum of 35, and the median Technical satisfaction was 20, with a maximum of 20. Using univariate analysis, the factors associated with variation in overall satisfaction were age, type of health insurance, hospital attended, change from baseline in pain level, pain score post-attention, change from baseline in oral health status and type of treatment received. In multivariate analyses, health insurance, pain score post-attention, variation in quality of life and type of treatment received were independent factors of variation on quality of life score. 1.4 Conclusions The primary driver of dental utilization of emergency departments among adults in three Chilean hospitals was pain. Although most patients had health insurance that covered the cost for emergency, visits their coverage typically did not extend to regular dental care. The care received by patients at dental emergency services is effective in relieving their dental pain and improving their oral health status. Additionally, the effectiveness of dental care did not vary across the three hospitals included in this study, when measured in change in dental pain, but it does vary across hospital, when measured in change in quality of life. Although the care received by patients seeking dental emergency services was highly satisfactory, dental care satisfaction varied across the three study hospitals.