Inappropriate Antibiotics Are Common in the Outpatient Care Setting

In appropriate prescribing of antibiotics is common in ambulatory care settings, according to a recently published research letter.

The authors of the research letter conducted a retrospective cohort study using the 2014 Truven Health MarketScan Commercial Claims and Encounters Database, including outpatient claims with facility codes for urgent care center, retail clinic, hospital-based emergency departments (EDs), or medical office were included. Using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, the authors assigned each visit a diagnosis. Data on systemic antibiotic prescriptions were collected using drug codes from the 2016 Truvel Health Red Book supplement.

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The author’s focus was on antibiotic-inappropriate respiratory diagnoses, including viral upper respiratory infection, bronchitis/bronchiolitis, asthma/allergy, influenza, nonsuppurative otitis media, and viral pneumonia.

Overall, antibiotic prescriptions were linked to 39.0% (n = 1,062,477) of 2.7 million urgent care visits, 36.4% (n = 21,177 of 58,206 retail clinic visits, 13.8% (n = 660,450) of 4.8 million ED visits, and 7.1% (n = 10,580,312) of 148.5 million medical office visits.

Visits for antibiotic-inappropriate respiratory diagnoses accounted for 17% (n = 10,009) of retail clinic visits, 16% (n = 441,605) of urgent care center visits, 6% (n = 9,203,276) of medical office visits, and 5% (n = 257,010) of ED visits.

Among these visits, inappropriate antibiotic prescription was most common in urgent care centers (45.7%) followed by EDs (24.6%), medical offices (17.0%), and retail clinics (14.4%).

“These patterns suggest differences in case mix and evidence of antibiotic overuse, especially in urgent care centers. This finding is important because urgent care and retail clinic markets are growing,” the authors concluded.

“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%.”

—Michael Potts

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.