Over-the-counter prescriptions at Urgent Care centers excessively utilized
In urgent care clinics across the nation, concerns about inappropriate prescribing of antibiotics, steroids, and opioids persist. This practice, which poses risks such as antibiotic resistance and the ongoing opioid crisis, demands attention and action.
Current guidelines champion antibiotic stewardship, clinician education, decision support tools, and multifaceted interventions as key strategies to enhance prescribing practices. Recent findings reveal that urgent care clinics frequently dispense these drugs inappropriately, with antibiotics prescribed for viral or non-bacterial infections like bronchitis (15%) and urinary symptoms (46%), steroids for sinusitis (24%) and bronchitis (41%), and opioids for conditions like muscle pain (5%) and sprains (4%).
Antibiotic Stewardship Programs, structured initiatives aimed at optimising antibiotic use, are a crucial component of the solution. These programs ensure correct diagnosis, drug choice, and treatment duration by, for example, requiring clinicians to document antibiotic duration at order entry, which can reduce unnecessary prolonged use.
Clinician Education and Feedback is another essential element. Engaging urgent care providers with ongoing education, such as specialized courses on antibiotic stewardship supported by the CDC and Urgent Care Association, helps increase guideline adherence.
Integrating Electronic Health Record (EHR) Clinical Decision Support can also guide providers during prescribing and flag inappropriate medications based on diagnosis and guidelines.
Given that inappropriate prescribing arises from clinician knowledge gaps, patient pressure, and limited decision support, a Multifaceted Approach is necessary. This approach combines education, stewardship, feedback, and technology to address the issue comprehensively.
Since urgent care has unique workflow and patient demand challenges, Urgent Care-Tailored Stewardship programs specific to urgent care settings are vital to reducing overuse of antibiotics, steroids, and opioids.
Together, these guidelines and solutions aim to minimise the risks of drug overuse, including antibiotic resistance and opioid addiction, by promoting the right drug, at the right dose and duration, for the right condition in urgent care clinics.
The study, based on insurance claims from a large national database, reveals that many people become dependent on opioids, and some move on to even stronger substances. Approximately one in eight visits led to an antibiotic prescription, and the country's opioid crisis serves as a stark reminder of what can happen when these drugs are distributed too freely. Overuse of steroids can make bacteria harder to treat and increase the chances of stronger, drug-resistant strains spreading in the community.
The patterns suggest that urgent care clinics may need better tools for smart prescribing, such as better training, alerts in their systems, and clearer rules about when these drugs should or shouldn't be used. The research, which included both adults and children, with more than half of the visits made by women, found that fewer visits resulted in steroid or opioid prescriptions.
However, the study's findings may not reflect what happens for people with different or no coverage. The results may not show the full picture of the patients' health or the doctor's explanations, as they are based on billing records. The study also looked at visits related to COVID-19 and found that steroid use jumped during that time.
Antibiotics were often prescribed for conditions where they don't work, such as certain ear infections, mild bladder symptoms, and common chest colds. In some cases, nearly half of the prescriptions for antibiotics didn't match up with any clear reason to use them. A better grasp of the risks associated with these drugs could lead to more careful choices in prescribing. Steroids were given out more often than needed, especially for coughs, sinus pressure, and chest congestion.
More programs focused on smart prescribing could help reduce the number of unnecessary medications prescribed and avoid the problems those drugs can cause later. The study's findings indicate that urgent care centers should work harder to ensure they're giving the right drugs at the right time. Opioids were handed out for minor injuries, stomach discomfort, and general muscle pain in situations that usually don't call for them. Even though opioid prescribing has gone down since its peak in the early 2010s, urgent care centers still lag behind in safer prescribing.
In conclusion, addressing inappropriate prescribing of antibiotics, steroids, and opioids in urgent care clinics is a critical task that requires a concerted effort from all stakeholders. By implementing guidelines and solutions such as antibiotic stewardship programs, clinician education, EHR clinical decision support, and multifaceted interventions, we can reduce the risks associated with drug overuse and promote safer, more effective healthcare in urgent care settings.
- To minimize the risks of antibiotic resistance and opioid addiction, urgent care clinics should consider implementing Antibiotic Stewardship Programs that ensure correct diagnosis, drug choice, and treatment duration.
- Integrating Electronic Health Record (EHR) Clinical Decision Support into these clinics can guide providers during prescribing and help reduce the number of inappropriate antibiotic prescriptions.
- A Multifaceted Approach, combining education, stewardship, feedback, and technology, is necessary to address the issue of inappropriate prescribing comprehensively, as it arises from clinician knowledge gaps, patient pressure, and limited decision support.
