Urgent Care & High Prescribing Rates
Urgent Care Prescribing Habits Under Scrutiny: High Rates of Inappropriate Antibiotic, Glucocorticoid, and Opioid Use Revealed
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Ann Arbor, MI – A complete study analyzing over 22 million urgent care visits has uncovered concerning trends in the prescription of antibiotics, glucocorticoids, and opioids, with a significant portion of these medications being dispensed for conditions where they are not clinically indicated. the research, published in Annals of Internal Medicine, highlights the urgent need for improved prescribing practices and stewardship programs within urgent care settings.
study Methodology and Scope
The large-scale analysis drew data from a substantial cohort of 22,426,546 urgent care visits. The patient demographic was diverse, with a median age of 49 years, and a notable majority of 56.6% (n = 8,640,819) being women. To ensure the accuracy of prescription appropriateness assessments, primary diagnosis codes were meticulously grouped into Clinical Classifications software Refined (CCSR) categories. Visits with missing or multiple primary diagnostic codes were excluded from the analysis.
To accurately attribute prescriptions to individual patient encounters, patients were only included if their visits were separated by more than three days. This methodology allowed researchers to examine inappropriate oral antibiotic, glucocorticoid, and opioid prescription fills across the 10 most common CCSR categories.
Key Findings: A Snapshot of Inappropriate Prescribing
The study’s findings paint a stark picture of prescribing patterns in urgent care:
Widespread prescription Fills: Out of the total 22,426,546 urgent care visits, a significant number resulted in prescription fills for the targeted drug classes. specifically, 2,783,924 visits (12.4%) led to antibiotic prescription fills, 2,038,506 visits (9.1%) to glucocorticoid fills, and 299,210 visits (1.3%) to opioid prescription fills.
Antibiotic Misuse: While antibiotics were appropriately prescribed for a majority of common bacterial infections, such as 58.2% (n = 169,782) of upper respiratory infections and 63.9% (n = 325,632) of urinary tract infections, they were frequently dispensed for conditions where they are never indicated. A notable example includes otitis media,where antibiotics were inappropriately filled in 30.66% (n = 33,001) of cases.
Glucocorticoid Overuse: Glucocorticoid prescriptions were found to be commonly issued,often inappropriately. The study identified high rates of glucocorticoid fills for upper respiratory infections (11.9%, n = 306,658), sinusitis (23.9%, n = 253,513), and acute bronchitis (40.8%,n = 190,302),conditions for which these potent anti-inflammatory drugs are generally not recommended.
Opioid Prescribing Patterns: Opioid prescriptions, while generally inappropriate for the conditions studied, were still prevalent. The analysis revealed that opioid fills were common for non-back musculoskeletal pain (4.6%, n = 28,048), abdominal pain and digestive symptoms (6.3%,n = 26,143),and sprains and strains (4.0%, n = 18,806).
Implications for Clinical Practice
The authors of the study emphasize that several factors likely contribute to the observed inappropriate prescribing in urgent care settings. These include clinician knowlege gaps, patient expectations and demands, and a lack of robust decision support tools at the point of care.”Inappropriate prescribing in urgent care is influenced by clinician knowledge, patient demands, and lack of decision support,” the authors stated. “Antibiotic, glucocorticoid, and opioid stewardship programs are needed to reduce inappropriate urgent care prescribing and support long-term glucocorticoid and opioid deprescribing efforts.”
The findings underscore the critical role of stewardship programs in promoting evidence-based prescribing and mitigating the risks associated with the overuse of these medications, including antibiotic resistance, adverse effects of glucocorticoids, and the ongoing opioid crisis.
Study Limitations and Future Directions
While this study provides valuable insights, certain limitations are acknowledged. The study population was restricted to insured patients, which may impact the generalizability of the findings to uninsured or underinsured populations. Moreover, the analysis was confined to the most common CCSR categories associated with each drug class, potentially leading to an underestimation of the overall extent of inappropriate prescribing.