Accessibility of Dental Appointments After Emergency Department Referral: An Audit Study

Dental pain and/or infection is a common reason for emergency department (ED) visits across the lifespan, highlighting the importance of connecting ED patients to dental care to address this driver of morbidity and repeat ED utilization. However, previous studies demonstrate challenges obtaining dental care after referral, with patients reporting difficulty obtaining appointments.This audit study evaluates the accessibility of routine dental care by insurance type.

We called dental clinics listed in public insurance directories in Boston, Philadelphia, and 5 Florida cities—areas ranging from lenient to restrictive dental insurance coverage— to request a routine appointment. Each clinic was contacted twice, 2 weeks apart: once using a public insurance patient profile and once using a private insurance profile. Outcomes included appointment availability (yes/no), number of days to appointment, and reasons for appointment unavailability. Descriptive analyses were performed and generalized linear regression models were used to calculate marginal adjusted effect estimates.

We contacted 296 clinics: 101 in Boston, 103 in Philadelphia, and 92 in Florida. An appointment could not be scheduled for 149/372 (40%) of Boston pediatric patients, 185/394 (47%) in Philadelphia, and 204/350 (58%) in Florida. Common reasons that appointments could not be scheduled included that clinics could not be reached after 3 contact attempts (32.7%), the listed number was not in service (18.0%), or the clinic did not accept the patient’s insurance (8.3%). There was variability in appointment availability across states by insurance and age group, with publicly insured pediatric patients more likely to secure an appointment in Philadelphia (OR=2.57, CI=1.16-5.69) and publicly insured adult patients less likely to secure an appointment in Boston (OR=0.34, CI=0.13-0.86) and Florida (OR=0.04, CI=0.01-0.14).

These findings demonstrate system level barriers to accessing dental care, driven by inability to reach clinics by phone, lack of accurate contact information, and non-acceptance of insurance. Our results suggest the need to strengthen networks of dental providers, particularly those that accept public insurance, and patient-facing contact directories to minimize barriers to care. Further study is needed to explore the variable impact of insurance by age group across cities.