Researchers examined differences in antibiotic prescribing activity in retail clinics, emergency departments and ambulatory care settings, with results published online July 16 in a research letter in JAMA: Internal Medicine. They found higher prescription rates in urgent care settings, both in all visits and antibiotic-inappropriate respiratory diagnoses.
The team—led by Danielle Palms, MPH, with the Centers for Disease Control in Atlanta—conducted a retrospective cohort study of claims data from individuals under 65 years old with employer-sponsored coverage.
Prescription rates varied significantly between the types of facilities visited by patients. Antibiotics were prescribed in 39 percent of the 2.7 million urgent care visits, 36.4 percent of 58,206 retail clinic visits, 13.8 percent of 4.8 million ED visits and 7.1 percent of 148.5 million medical office visits.
“Antibiotic stewardship interventions could help reduce unnecessary antibiotic prescriptions in all ambulatory care settings, and efforts targeting urgent care centers are urgently needed,” wrote Palms et al.
Such variance extended when examining antibiotic-inappropriate respiratory diseases, in particular. Prescription rates were 45/7 percent for urgent care centers, 24.6 for EDs, 17 percent for medical offices and 14.4 retail clinics.
The urgency from the authors is partially a result of economic trends, as urgent care centers and retail clinics are quickly growing in market share. Of all outpatient prescriptions, the researchers approximated 60 percent come from traditional outpatient care, while the remaining 40 percent may come from urgent care centers and retail clinics.
“There was substantial variability between settings in the percentage of visits at which antibiotics were prescribed among all visits and among visits for antibiotic inappropriate respiratory diagnoses,” Palms et al. wrote. “These patterns suggest differences in case mix and evidence of antibiotic overuse, especially in urgent care centers.”
Previous research suggested 30 percent of prescriptions written in a physician’s office or ED were unnecessary. Considering the rates of antibiotic prescription in other facilities, the authors noted, inappropriate prescription rates may be much higher than this accepted estimate.
Nicholas joined TriMed in 2016 as the managing editor of the Chicago office. After receiving his master’s from Roosevelt University, he worked in various writing/editing roles for magazines ranging in topic from billiards to metallurgy. Currently on Chicago’s north side, Nicholas keeps busy by running, reading and talking to his two cats.