Study Cites Urgent Care Clinics for Inappropriate Prescribing

 

• A large analysis of U.S. urgent care visits from 2018 to 2022 found high rates of inappropriate prescribing for antibiotics, glucocorticoids, and opioids.
• Visits related to COVID were associated with a lower share of antibiotic prescription fills but a higher share of glucocorticoid fills.
• "Stewardship programs are needed to reduce inappropriate urgent care prescribing," the researchers said.

Urgent care clinics often inappropriately prescribed antibiotics, glucocorticoids, and opioids for common conditions, found a cross-sectional study involving more than 22 million U.S. patient visits from 2018 to 2022.

For antibiotics, there were high rates of prescribing for "never appropriate" indications such as otitis media (31%), genitourinary signs and symptoms (46%), and acute bronchitis (15%), reported Shirley Cohen-Mekelburg, MD, of the University of Michigan in Ann Arbor, and co-authors in Annals of Internal Medicineopens in a new tab or window.

Glucocorticoid prescriptions were generally inappropriate for visits related to upper respiratory infection (12%), sinusitis (24%), and acute bronchitis (41%), while opioid prescriptions were generally inappropriate for visits related to non-back musculoskeletal pain (5%), abdominal pain and digestive symptoms (6%), and sprains and strains (4%).

Visits related to COVID-19 were associated with a lower share of antibiotic prescription fills but a higher share of glucocorticoid fills when compared with visits for other reasons, the study found.

Inappropriate antibiotic, glucocorticoid, and opioid prescribing can result in preventable harms, the researchers said, and it can occur more often at urgent care clinics than in other treatment settings.

A previous studyopens in a new tab or window of respiratory diagnoses found inappropriate antibiotic prescribing among 16% of urgent care visits versus 6% of office visits and 5% of emergency setting visits, where antibiotic stewardship programs are more established, according to Cohen-Mekelburg and colleagues. In the current study, antibiotic prescriptions were appropriate most of the time for upper respiratory infections (58.2%) and urinary tract infections (63.9%).

"Inappropriate prescribing in urgent care is influenced by clinician knowledge, patient demands, and lack of decision support," Cohen-Mekelburg and co-authors wrote. "Antibiotic, glucocorticoid, and opioid stewardship programs are needed to reduce inappropriate urgent care prescribing and support long-term glucocorticoid and opioid prescribing efforts."

Andrew Kolodny, MD, of Brandeis University in Waltham, Massachusetts, told MedPage Today that opioid prescribing in general has been trending in the right direction since it peaked around 2012 to 2013.

The current data show "us that we've got a long way to go when it comes to urgent care settings," added Kolodny, who was not involved in the study.

Kolodny, who is the medical director of the Opioid Policy Research Collaborative at the university, also called for increased education.

"I think that opioids are generally overprescribed when the medical staff underappreciates the risks," he said. "If the clinicians understood that their prescriptions were more likely to harm patients than help them, I think they'd prescribe more cautiously."

The study from Cohen-Mekelburg's group included outpatients of all ages, where an urgent care place-of-service code was used from January 2018 to December 2022. The authors identified 10.8 million patients involved in 22.4 million urgent care visits. In all, 56% were female and the median age was 34, with 12.4% of visits resulting in antibiotic prescription fills, 9.1% in glucocorticoid fills, and 1.3% in opioid fills.

Researchers leveraged the Merative MarketScan Commercial and Medicare Supplement databases, which includes data on more than 270 million Americans and 12.9 million Medicare supplemental beneficiaries. The authors pulled together a number of primary diagnosis codes under Clinical Classifications Software Refined (CCSR) categories, excluding visits with missing or multiple primary diagnostic codes, which would make determining appropriateness of a prescription difficult.

The primary outcome was inappropriate prescription fills for all three types of drugs for the 10 most common CCSR categories.

For antibiotics, appropriateness was based on "established consensus schemes." For glucocorticoids, appropriateness was based on studies showing that their use was "generally inappropriate for upper respiratory infections, sinusitis, acute bronchitis, infectious diseases, and otitis media," and opioid prescriptions were deemed "generally inappropriate" for most diagnoses.

Study limitations included that all patients were insured so the findings may not be generalizable to the uninsured or other types of insurance. Additionally, the authors limited diagnosis codes to the most common CCSR categories tied to each of the drug types, which "may underestimate inappropriate prescribing," they noted. Also, the study's reliance on administrative data (using claims to classify diagnoses) means researchers had little insight into data on the demographic, clinicians or facilities, or confirmation of medication administration.

Disclosures

Cohen-Mekelburg disclosed no relationships with industry.

Co-authors disclosed support from the National Cancer Institute and the Department of Veterans Affairs.

Primary Source

Annals of Internal Medicine

Source Reference: opens in a new tab or windowCohen-Mekelburg S, et al "Antibiotic, glucocorticoid, and opioid prescribing in urgent cares: An opportunity for reducing medication overuse" Ann Intern Med 2025; DOI: 10.7326/ANNALS-24-04111.

https://www.medpagetoday.com/publichealthpolicy/practicemanagement/116611