From the Journals

Urgent care and retail clinics fuel inappropriate antibiotic prescribing

 

Key clinical point: Inappropriate antibiotic prescribing may be of particular concern in urgent care centers and other ambulatory care settings.

Major finding: For respiratory diagnoses where antibiotics would be inappropriate, such as viral upper respiratory infections, antibiotics were nevertheless prescribed in 45.7% of urgent care visits.

Study details: A retrospective cohort study including claims from 2014 in a database for individuals 65 years of age or younger with employer-sponsored insurance.

Disclosures: The research was funded by the Centers for Disease Control and Prevention. The authors reported no conflicts of interest.

Source: Palms DL et al. JAMA Intern Med. 2018 Jul 16.

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Urgent care incentives out of alignment

This study suggests urgent care and retail clinics are “underrecognized” contributors to the ongoing problem of inappropriate antibiotic prescribing, according to authors of an invited commentary.

The urgent care sector, a $15 billion business representing more than 10,000 U.S. high-volume clinics, is growing very rapidly due to convenient locations, same-day access to care, and lower out-of-pocket expenditures versus emergency departments, the authors said.

“Lowering barriers for an office visit to such a degree may prompt frequent visits for mild self-resolving illnesses that would be better treated with rest and symptom management at home,” they wrote.

Innovations such as telephone triage lines could help reduce inappropriate antibiotic prescribing, but might “conflict with the business model” of urgent care and retail clinics, they added.

“Unfortunately, we all pay – in increased insurance premiums and increased antibiotic resistance – from the overprescribing of antibiotics for upper respiratory tract infections,” they wrote.

Michael A. Incze, MD, MSEd, and Rita F. Redberg, MD, MSc, are with the department of medicine, University of California, San Francisco. Mitchell H. Katz, MD, is with New York City Health and Hospitals. These comments are based on their invited commentary appearing in JAMA Internal Medicine . All three authors reported having no conflicts of interest.


 

FROM JAMA INTERNAL MEDICINE

When it comes to inappropriate antibiotic prescribing, urgent care centers and retail clinics may have an outsized impact, a review of commercial insurance claims suggests.

Antibiotic prescription rates were at least twice as high in those settings, compared with emergency departments and medical office visits, according to the retrospective analysis.
The issue may be particularly pronounced in urgent care centers, based on this study, in which nearly half of visits for antibiotic-inappropriate respiratory diagnoses resulted in antibiotic prescribing.

Those findings suggest a need for “antibiotic stewardship interventions” to reduce unnecessary prescribing of antibiotics in ambulatory care settings, authors of the analysis reported in a research letter to JAMA Internal Medicine.

“Efforts targeting urgent care centers are urgently needed,” wrote Danielle L. Palms, MPH, of the Centers for Disease Control and Prevention, Atlanta, and her coauthors.

The retrospective study by Ms. Palms and her colleagues included claims from 2014 in a database of individuals 65 years of age or younger with employer-sponsored insurance.

The researchers included encounters in which medical and prescription coverage data were captured, including approximately 2.7 million urgent care center visits, 58,000 retail clinic visits, 4.8 million emergency department visits, and 148.5 million medical office visits.

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They found antibiotic prescriptions linked to 39.0% of urgent care and 36.4% of retail clinic visits, compared with 13.8% of emergency department visits and 7.1% of medical office visits.

For respiratory diagnoses where antibiotics would be inappropriate, such as viral upper respiratory infections, antibiotics were nevertheless prescribed in 45.7% of urgent care visits, compared with 24.6% of emergency department, 17.0% of medical office visits, and 14.4% of retail clinic visits.

Those data show “substantial variability” that suggests case mix differences and evidence of antibiotic overuse, particularly in the urgent care setting, the researchers said in their letter.

In another recent study, looking at the 2010-2011 period, at least 30% of antibiotic prescriptions written in U.S. physician offices and emergency departments were unnecessary.

“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%,” wrote Ms. Palms and her coinvestigators.

The research was funded by the Centers for Disease Control and Prevention. Ms. Palms and her coauthors reported no conflicts of interest.

SOURCE: Palms DL et al. JAMA Intern Med. 2018 Jul 16.

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