Urgent Care Centers Often Prescribe Unnecessary Antibiotics

Patients with respiratory conditions that can’t be fixed with antibiotics, such as bronchitis and the common cold, often walk out of urgent care centers with a prescribed antibiotic despite them being unnecessary, according to study findings.

When compared to other sites of care, these patients are more likely to receive antibiotics unnecessarily. Researchers found that nearly half of patients visiting urgent care centers who were diagnosed with an acute respiratory condition, for which antibiotics are neither recommended nor effective, came away with an antibiotic prescription.

These findings, published in JAMA Internal Medicine, are a result of research from The Pew Charitable Trusts and the CDC, which looked at antibiotic use in retail health clinics—located in businesses such as pharmacies and grocery stores—and urgent care centers, both of which play a large role in providing outpatient care and prescribing medications in the United States. These 2 sites of care likely contribute to 40% of antibiotic prescribing in the country.

Despite antibiotic overuse contributing to antibiotic resistance, which can lead to adverse events, overuse remains a common occurence in the United States. To pinpoint trends in prescribing, researchers conducted the retrospective study using the 2014 Truven Health MarketScan Commercial Claims and Encounters Database, which includes claims data on individuals under age 65 with employer-sponsored insurance. Antibiotic-inappropriate respiratory diagnoses included: viral upper respiratory infection, bronchitis/bronchiolitis, asthma/allergy, influenza, nonsuppurative otitis media, and viral pneumonia.

Of 2.7 million urgent care center visits, 39% resulted in antibiotic prescriptions. Not far behind, 36.4% of 58,206 retail clinic visits resulted in prescriptions. Meanwhile, 13.8% of 4.8 million emergency department (ED) visits and 7.1% of 148.5 million medical office visits resulted in written prescriptions.

Looking at antibiotic-inappropriate respiratory diagnoses, they accounted for 17% of retail clinic visits, 16% of urgent care center visits, 6% of medical office visits, and 5% of emergency department visits. Among these visits, nearly half (46%) of urgent care center visits led to antibiotic prescriptions, compared to just 14.4% of retail clinics. Additionally, 24.6% of ED visits and 17% of medical offices resulted in written prescriptions.

The higher chance of inappropriate prescribing at urgent care centers and retail clinics is particularly troubling because a growing number of Americans are turning to these outpatient settings for care that they can no longer afford or access in a timely fashion from a primary care provider, said Rita Redberg, MD, a professor at the University of California San Francisco Medical Center, in an email.

Also underscoring the importance of these findings, the study’s researchers noted that, “Antibiotic stewardship interventions could help reduce unnecessary antibiotic prescriptions in all ambulatory care settings, and efforts targeting urgent care centers are urgently needed.”

Reference:

Palms D, Hicks L, Bartoces M, et al. Comparison of antibiotic prescribing in retail clinics, urgent care centers, emergency departments, and traditional ambulatory care settings in the United States [published online July 16, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.1632.