Inappropriate prescriptions for antibiotics, glucocorticoids and opioids common at urgent cares

Urgent care visits commonly result in inappropriate prescriptions of antibiotics, glucocorticoids or opioids, according to a letter in the Annals of Internal Medicine.

Michigan Medicine researchers examined commercial and Medicare Supplemental databases to study 22,426,546 urgent care visits, which resulted in 2,783,924 (12.4%) antibiotic, 2,038,506 (9.1%) glucocorticoid, and 299,210 (1.3%) opioid prescriptions.

In each category, they identified a substantial number of prescriptions that were filled despite being "never appropriate" or "generally inappropriate" given the patients' diagnoses.

"Previous studies had shown that patients continue to receive antibiotics for diagnoses where they may not be indicated, such as for a viral respiratory infection, especially in urgent care settings,” said Shirley Cohen-Mekelburg, M.D., M.S., assistant professor of internal medicine at the University of Michigan Medical School and co-lead author on the article.

“Our findings reveal that this trend of inappropriate prescribing includes other classes of drugs—including glucocorticoids—and a variety of conditions.”

Among the “never appropriate” indications, antibiotics were prescribed for 30.7% of patients diagnosed with otitis media, 45.7% with genitourinary symptoms and 15.0% with acute bronchitis.

Previous studies have shown high rates of inappropriate prescriptions for respiratory tract infections.

The researchers cite one study which found inappropriate antibiotic prescribing in 16% of urgent care visits, compared to 6% and 5% in office and emergency visits, respectively.

Glucocorticoid prescriptions were sorted into categories of “potentially appropriate” or “generally inappropriate,” depending on the diagnosis.

Among the indications for which they were deemed generally inappropriate, glucocorticoids were prescribed in 23.9% of sinusitis, 40.8% of acute bronchitis and 7.9% of otitis media cases.

Urgent care centers prescribed opioids in a variety of generally inappropriate cases, including non-back musculoskeletal pain (4.6% of cases), abdominal pain and digestive symptoms (6.3%), and sprains and strains (4.0%).

The authors attribute these trends to “clinician knowledge, patient demand and lack of decision support.”

They suggest a variety of potential solutions, including drug stewardship programs, electronic health record programs and education.

The article urges that future studies focus on the development of urgent care-tailored stewardship programs.

“Reducing inappropriate prescribing of antibiotics, glucocorticoids and opioids will require a multifaceted approach,” Cohen-Mekelburg said.

“Providers at urgent centers would benefit from greater support and feedback in making these decisions.”