Inappropriate Antibiotic Prescriptions Highest Among Urgent Care Facilities

The inappropriate prescribing of antibiotics varies among retail clinics, urgent care centers, medical offices, and emergency departments, according to a study recently published in JAMA Internal Medicine. Antibiotic overprescription was highest among urgent care centers.

Of 2.7 million visits to urgent care centers, 1,062,477 (39.0%) visits resulted in the prescription of antibiotics (95% CI, 39.0%-39.1%). Additionally, antibiotics were prescribed in 21,177 (36.4%) of 58,206 visits to retail clinics (95% CI 36.0%-36.8%), 660,450 (13.8%) of 4.8 million visits to emergency departments (95% CI 13.8%-13.8%), and 10,580,312 (7.1%) of 148.5 million visits to medical offices (95% CI 7.1%-7.1%).

Respiratory diagnoses related to inappropriate antibiotic prescription resulted in 441,605 (16%) visits to urgent care facilities, 10,009 (17%) visits to retail clinics, 257,010 (5%) of visits to emergency departments, and 9,203,276 (6%) visits to medical offices. Inappropriate antibiotic prescriptions were highest among urgent care facilities (45.7%), with emergency departments (24.6%), medical offices (17.0%), and retail clinics (14.4%) following.

The 2014 Truven Health MarketScan Commercial Claims and Encounters Database was utilized to access claims data. Unique visits were the unit of analysis, and the outcome was visits resulting in antibiotic prescriptions arranged by diagnosis and setting. Antibiotic-inappropriate respiratory diagnoses included bronchitis, bronchiolitis, asthma, allergies, influenza, viral pneumonia, nonsuppurative otitis media, and viral upper respiratory infection. Binomial distributions were used to calculate 95% CIs. 

The researchers concluded, “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. These patterns suggest differences in case mix and evidence of antibiotic overuse, especially in urgent care centers …. The finding of the present study that antibiotic prescribing for antibiotic-inappropriate respiratory diagnoses was highest in urgent care centers suggests that unnecessary antibiotic prescribing nationally in all outpatient settings may be higher than the estimated 30%.”

Reference

Palms DL, Hicks LA, 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