In the Journals

Variation in antibiotic prescribing at urgent care centers is ‘intense’

Edward Stenehjem, MD, MSc
Edward Stenehjem

An analysis of more than 1.1 million urgent care encounters in a large health care network revealed an “intense” variation in their antibiotic prescribing practices, according to a recent study. Researchers said the data can help to inform and improve stewardship programs.

“The CDC identified urgent care as a rapidly growing health care delivery platform. In addition, a recent national study indicated that across all health care settings, urgent cares have both the highest percentage of visits resulting in antibiotic prescriptions and the highest rate of inappropriate prescribing for respiratory tract infections,” Edward Stenehjem, MD, MSc, medical director of antibiotic stewardship at Intermountain Healthcare, told Infectious Disease News. “Clearly, based on these two findings, urgent care is a very high-priority target for stewardship.”

Focusing on respiratory tract conditions, Stenehjem and colleagues characterized antibiotic prescribing practices during urgent care encounters in a retrospective cohort study conducted at 39 clinics in the Intermountain Healthcare network.

According to the results, antibiotics were prescribed during 34% of the 1.16 million recorded encounters. Respiratory conditions accounted for 61% of encounters, with 50% resulting in antibiotic prescriptions. Of all respiratory encounters where an antibiotic was prescribed, tier 2 conditions such as otitis media, pharyngitis and sinusitis accounted for 65% of prescriptions, Stenehjem explained. 

According to the study, depending on the provider, antibiotics were prescribed during as few as 3% of encounters and in as many as 94%. Similar variability between providers was observed for respiratory conditions where antibiotics were not indicated and in first-line antibiotic selection for sinusitis, otitis media and pharyngitis.

“We’ve highlighted that the variation in antibiotic prescribing between providers is intense,” Stenehjem said. “These findings suggest that peer-comparison stewardship interventions, used successfully in primary care, could be used in [urgent cares] and may need to be more intensively targeted toward selected clinicians with poor performance.”

Additionally, he said the findings highlight the importance of tier 2 respiratory conditions and that stewardship interventions that target tier 2 respiratory conditions have the potential for substantial impact through ensuring appropriate diagnoses to reduce unnecessary antibiotic use, using delayed prescriptions for sinusitis and acute otitis media, and promoting appropriate antibiotic selection.

“Most encounters were for infectious disease conditions and substantial variability in antibiotic prescribing practices existed at the level of individual providers,” Stenehjem concluded. “Infectious diseases and antibiotic stewardship need to partner with urgent care clinics. This growing health care delivery mechanism is here to stay, and we need to partner with them to improve antibiotic use.” – by Caitlyn Stulpin

Disclosures: Stenehjem reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosure.

 
Edward Stenehjem, MD, MSc
Edward Stenehjem

An analysis of more than 1.1 million urgent care encounters in a large health care network revealed an “intense” variation in their antibiotic prescribing practices, according to a recent study. Researchers said the data can help to inform and improve stewardship programs.

“The CDC identified urgent care as a rapidly growing health care delivery platform. In addition, a recent national study indicated that across all health care settings, urgent cares have both the highest percentage of visits resulting in antibiotic prescriptions and the highest rate of inappropriate prescribing for respiratory tract infections,” Edward Stenehjem, MD, MSc, medical director of antibiotic stewardship at Intermountain Healthcare, told Infectious Disease News. “Clearly, based on these two findings, urgent care is a very high-priority target for stewardship.”

Focusing on respiratory tract conditions, Stenehjem and colleagues characterized antibiotic prescribing practices during urgent care encounters in a retrospective cohort study conducted at 39 clinics in the Intermountain Healthcare network.

According to the results, antibiotics were prescribed during 34% of the 1.16 million recorded encounters. Respiratory conditions accounted for 61% of encounters, with 50% resulting in antibiotic prescriptions. Of all respiratory encounters where an antibiotic was prescribed, tier 2 conditions such as otitis media, pharyngitis and sinusitis accounted for 65% of prescriptions, Stenehjem explained. 

According to the study, depending on the provider, antibiotics were prescribed during as few as 3% of encounters and in as many as 94%. Similar variability between providers was observed for respiratory conditions where antibiotics were not indicated and in first-line antibiotic selection for sinusitis, otitis media and pharyngitis.

“We’ve highlighted that the variation in antibiotic prescribing between providers is intense,” Stenehjem said. “These findings suggest that peer-comparison stewardship interventions, used successfully in primary care, could be used in [urgent cares] and may need to be more intensively targeted toward selected clinicians with poor performance.”

Additionally, he said the findings highlight the importance of tier 2 respiratory conditions and that stewardship interventions that target tier 2 respiratory conditions have the potential for substantial impact through ensuring appropriate diagnoses to reduce unnecessary antibiotic use, using delayed prescriptions for sinusitis and acute otitis media, and promoting appropriate antibiotic selection.

“Most encounters were for infectious disease conditions and substantial variability in antibiotic prescribing practices existed at the level of individual providers,” Stenehjem concluded. “Infectious diseases and antibiotic stewardship need to partner with urgent care clinics. This growing health care delivery mechanism is here to stay, and we need to partner with them to improve antibiotic use.” – by Caitlyn Stulpin

Disclosures: Stenehjem reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosure.