ED return high, dermatology follow-up low after index ED visit for hidradenitis suppurativa

Following an ED visit for hidradenitis suppurativa treatment, patients had a low rate of dermatology outpatient follow-up and a high rate of return ED visits for HS treatment within 180 days, according to a study.

Additionally, the researchers found that having Medicaid vs. commercial insurance and receiving an opioid prescription at the index ED visit were high indicators for a return ED visit.

“Although it has been demonstrated that patients with HS have high ED utilization for their disease and relatively low outpatient utilization, it is unclear what ED interventions and patient characteristics may be associated with these outcomes,” Cynthia X. Wang, MD, MPHS, of the division of dermatology in the department of medicine at Washington University School of Medicine in St. Louis, and colleagues wrote. “The primary purpose of this cohort study was to investigate ... which interventions and patient characteristics were associated with ED return and dermatology follow-up within 30 and 180 days.”

In this retrospective cohort study, Wang and colleagues collected and analyzed data from the IBM MarketScan commercial and multi-state Medicaid databases from 2010 to 2019. The study included 20,269 patients with HS (median age, 32 years; range, 18-64 years; 82.9% women) with at least two diagnosis claims of HS and one ED visit resulting from HS. A total of 36.8% of patients had commercial insurance while 63.2% had Medicaid. During the ED visit, 48% of patients received an incision and drainage procedure, 72.6% received oral antibiotic prescription and 48.9% received opioid medical prescription.

Results showed that dermatology out-patient follow-up within 30 and 180 days was low (2.4% and 6.8%, respectively), while at least one ED return visit within the same time frames was high (17.2% and 34%). Patients with Medicaid and those who received an opioid prescription at their index ED visit were more likely to return to the ED (OR = 1.48; 95% CI, 1.38-1.58; and OR = 1.48; 95% CI, 1.39-1.58) and less likely to visit the dermatologist (OR = 0.16; 95% CI, 0.14-0.18; and OR = 0.81; 95% CI, 0.71-0.91) within 180 days.

“Factors such as opioid prescription after ED visit and Medicaid status were associated with increased odds of ED return but lower odds of dermatology follow-up,” Wang and colleagues wrote. “Future investigations are needed to understand the reasons underlying these patterns and to aid with interventions to address these critical gaps in care.”