Half of all eye-related visits to U.S. emergency departments are for non-emergent conditions, according to a new report.
“Interventions to facilitate management of these cases outside the ED could make ED resources more available for truly emergent ophthalmic and medical issues,” researchers write in JAMA Ophthalmology.
For the study, Dr. Roomasa Channa from the Wilmer Eye Institute at Johns Hopkins Hospital in Baltimore, Maryland, and colleagues used nationally representative data from the U.S. Nationwide Emergency Department Sample (NEDS).
They categorized a weighted count of 11.9 million eye-related emergency department visits as emergent or non-emergent. The data spanned the six years from 2006 through 2011.
Of those cases, 41.2 percent were emergent and 44.3 percent were non-emergent (14.5 percent could not be determined).
Corneal abrasions and a foreign body in the external eye were the leading diagnoses in the emergent category. They accounted for 13.7 percent and 7.5 percent of total visits, respectively.
Emergent visits were significantly more likely to occur among males (odds ratio, 2.00), patients in the highest income quartile (OR, 1.47), older patients (OR, 2.38), and those with private insurance (OR, 1.29).
Non-emergent conditions accounted for over 4 million of all eye-related emergency department visits. Being younger and female, with a lower income and on Medicaid were significantly associated with these visits.
Mean annual inflation-adjusted charges for all eye-related emergency department visits totaled $2 billion.
“Non-urgent care costs two to three times more when provided in the emergency department compared with similar visits in other settings,” the researchers note.
The top non-emergent diagnoses were conjunctivitis (28.0 percent), subconjunctival hemorrhages (3.0 percent), and styes (3.8 percent).
“All three are non-vision threatening conditions that can be easily treated in doctors’ offices or urgent care centers,” she said.
Interventions to facilitate management of these cases outside the emergency department could free up resources for treatment of emergent ophthalmic and medical conditions, and potentially decrease health care costs, she said.
“This paper highlights a mismatch between what people need from their health care system and what the system is currently giving them access to,” said Dr. Venkatesh Bellamkonda, an emergency physician at the Mayo Clinic in Rochester, Minnesota, who was not involved in the study.
In an email to Reuters Health, he said that use of emergency departments for non-emergent eye-related problems is likely to continue until the mismatch between the need for care and access to it is eliminated.
“This study is a springboard to further inquiry as to what limitations or barriers people experience when trying to pursue treatment in venues other than the emergency department for eye problems like conjunctivitis,” Dr. Bellamkonda said.