Stewardship programs are needed reduce inappropriate urgent care prescribing of antibiotics, glucocorticoids and opioids.
RT’s Three Key Takeaways:
- Inappropriate prescribing is widespread—over 12% of urgent care visits resulted in antibiotic prescriptions, with nearly a third written for conditions like otitis media where they’re rarely appropriate.
- Glucocorticoids and opioids are also misused, with nearly 41% of glucocorticoid prescriptions given for acute bronchitis and opioids often prescribed for non-severe conditions like strains and digestive pain.
- Targeted stewardship programs are urgently needed to address inappropriate prescribing in urgent care settings and reduce preventable medication-related harms.
A cross-sectional study assessed inappropriate antibiotic, glucocorticoid, and opioid prescribing in urgent care visits in the US. Researchers found that urgent care visits are commonly associated with inappropriate antibiotic, glucocorticoid, and opioid prescribing, revealing the need for multifaceted programs to reduce inappropriate prescribing and mitigate potential harm, according to data in Annals of Internal Medicine.
Researchers from the University of Michigan, Ann Arbor and colleagues used the Merative MarketScan Commercial and Medicare Supplemental databases to study urgent care outpatients of all ages between 1 January 2018 and 31 December 2022. The primary outcome was inappropriate oral antibiotic, glucocorticoids, and opioid prescription fills for the 10 most common Clinical Classifications Software Refined (CCSR) categories.
Antibiotic appropriateness was based on established consensus schemes. Glucocorticoid appropriateness was based on literature defining glucocorticoid use as generally inappropriate for upper respiratory infections, sinusitis, acute bronchitis, infectious diseases, and otitis media.
Opioid prescription fills were considered generally inappropriate. Of 10,773,218 patients identified from 22,426,546 urgent care visits, 12.4%, 9.1%, and 1.3% of visits led to antibiotic, glucocorticoid, and opioid prescriptions, respectively. Antibiotics were frequently filled for never-appropriate indications, with 30.66% of prescriptions filled for otitis media. 40.8% of glucocorticoid prescriptions were inappropriately filled to treat acute bronchitis.
Opioid prescriptions were commonly inappropriately filled for non-back musculoskeletal pain, abdominal pain and digestive symptoms, and sprains and strains. A subgroup analysis found that COVID-19 related visits led to lower antibiotic prescriptions and higher glucocorticoid prescriptions.
The study highlights the need for stewardship programs to reduce inappropriate urgent care prescribing, and future studies should focus on identifying components for urgent care–tailored stewardship programs.
Delayed antibiotic treatment for digestive issues which can be colitis, hernia rupture,diverticulitis ,UTI affecting all or involve the bladder, more often than not leads to sepsis, so strongly disagree to withhold antibiotics in these cases. You cannot generalize stating to refrain from prescribing a life saving antibiotic, giving time for follow up.