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Urgent Care Centers Show Lackluster Antibiotic Stewardship

Almost half of visits to urgent care centers led to an unnecessary antibiotic prescription, indicating the need for improved antibiotic stewardship in these settings.

Urgent care centers show lackluster antibiotic stewardship

Source: Thinkstock

By Jessica Kent

- Nearly forty-six percent of urgent care center visits resulting in an antibiotic prescription were for conditions that do not call for antibiotic treatment , revealing that more robust antibiotic stewardship programs (ASPs) may be necessary in these settings, according to a study from The Pew Charitable Trusts and the CDC.   

Pew noted that individuals make approximately 160 million visits to these outpatient clinics each year. Because most antibiotic use occurs in outpatient facilities, urgent care centers play an important role in combating inappropriate prescribing and antibiotic resistance.

The healthcare industry’s lack of antibiotic stewardship has resulted in drug-resistant superbugs, patient deaths from untreatable infections, and increased care costs.

The CDC previously found that nearly 80 percent of inpatient hospitals may be overusing antibiotics, and both Pew and the CDC have investigated prescribing rates in outpatient settings, including physicians’ offices, emergency departments (EDs), and hospital specialty clinics.  

However, investigations about antibiotic stewardship in the urgent care environment are less common.  

To determine the amount of antibiotic prescriptions resulting from urgent care visits, researchers matched medical and pharmaceutical claims for antibiotics within three days of patients’ appointments at urgent care centers.

The results showed that in total, nearly two in five visits to urgent care centers led to antibiotic prescriptions.

Of those visits, 46 percent resulted in prescriptions for common conditions that are unresponsive to antibiotic treatment, including the common cold, bronchitis, and viral pneumonia.

Researchers found that this rate was significantly higher than in other outpatient facilities. In retail clinics, emergency departments, and office-based clinics, appointments for these conditions resulted in antibiotic prescriptions between 14 and 25 percent of the time.

Although prescriptions for respiratory infections are the most avoidable and unnecessary, they constitute a significant portion of antibiotic prescriptions. A 2016 study from the CDC found that of the nearly one in three unnecessary antibiotic prescriptions written each year, 44 percent are intended to treat respiratory infections.

“Antibiotics are lifesaving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” Tom Frieden, MD, MPH, CDC Director, said at the time.

“Losing these antibiotics would undermine our ability to treat patients with deadly infections, cancer, provide organ transplants, and save victims of burns and trauma.”

The urgent care study also revealed high levels of prescriptions for three common conditions that do not always need antibiotic treatment, including sinus infections, middle ear infections, and pharyngitis.

Patients with sinus infections received antibiotics in 82 percent of urgent care appointments, but in just 68 percent of ED visits.

Urgent care clinicians prescribed antibiotics for middle ear infections in 83 percent of visits, while ED providers ordered antibiotic treatment for this diagnosis in 72 percent of visits.  

Sixty percent of pharyngitis diagnoses resulted in antibiotic prescriptions in urgent care facilities, compared with 47 percent of pharyngitis cases in ED visits.

Pew asserted that increased stewardship efforts within urgent care centers will help providers ensure they are prescribing these treatments only when necessary.

The analysis did have several limitations, including the fact that the number of urgent care visits studied was relatively small compared with the total number of visits these facilities experience annually.

Additionally, the study did not include patients covered by private insurance, which limits the ability to generalize the results.

However, the research does show that antibiotic stewardship efforts may be beneficial in urgent care settings, as these clinics provide care for a growing number of patients.

Implementing ASPs in urgent care clinics would further combat antibiotic resistance, ultimately resulting in improved patient outcomes and lower care costs.

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