By Stan Deresinski, MD, FACP, FIDSA
Clinical Professor of Medicine, Stanford University
Dr. Deresinski reports no financial relationships relevant to this field of study.
SYNOPSIS: Urgent care centers, which are part of a growth industry, are responsible for a large proportion of antibiotic prescriptions, including inappropriate prescriptions for acute respiratory diagnoses.
SOURCE: 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. JAMA Intern Med 2018; Jul 16. doi: 10.1001/jamainternmed.2018.1632. [Epub ahead of print].
Palms et al retrospectively analyzed differences in antimicrobial prescribing in urgent care centers, retail clinics, and EDs in the United States, using the 2014 Truven Health MarketScan Commercial Claims and Encounters Database. This database contains claims information on persons < 65 years of age who receive employer-sponsored health insurance. The database included 2.7 million urgent care visits, 58,206 retail clinic visits, 4.8 million ED visits, and more than 10 million medical office visits. The frequencies of antibiotic prescriptions were 39.0%, 36.4%, 13.8%, and 7.1%, respectively. Antibiotic prescribing for “antibiotic-inappropriate” acute respiratory diagnoses also was highest in urgent care centers (45.7%), with EDs coming in second (24.6%), followed by medical offices (17.0%) and retail clinics (14.4%).
As the authors noted, these data suggest that prior estimates that at least 30% of antibiotics prescribed in physician’s offices and EDs were unnecessary provides an underestimate of all outpatient prescribing, given the outsize contribution to unnecessary prescribing in urgent care centers.
These data demonstrate the need to implement outpatient antimicrobial stewardship. Further, in addition to the usually considered sites, this effort should target urgent care centers. Addressing this issue is critical given the remarkable growth in what has become an $18 billion industry. Urgent care centers, where the leading diagnostic category is acute respiratory infections, reported a 1,725% increase in claims from 2007 to 2016 (compared to only 229% in EDs).1