Unnecessary Over-prescription of Routine Medications at Urgent Care Centers

Unnecessary Over-prescription of Routine Medications at Urgent Care Centers

In a recent study, it was revealed that urgent care clinics may be contributing to a significant health issue: overprescribing of antibiotics, opioids, and steroids [1][2]. These practices can lead to adverse health outcomes for patients and pose broader public health risks.

The study, based on billing records from a large national database, found that antibiotics were often prescribed for conditions where they don't work, such as certain ear infections, mild bladder symptoms, and common chest colds [3][4]. In some cases, nearly half of the prescriptions for antibiotics didn't match up with any clear reason to use them.

Opioids were also overprescribed for minor injuries, stomach discomfort, and general muscle pain in situations that usually don't call for them. Overprescribing of antibiotics can make bacteria harder to treat and increase the chances of stronger, drug-resistant strains spreading in the community. This is a growing health crisis, as antibiotic resistance continues to be a major concern [3][4].

Steroids were also given out more often than needed, especially for coughs, sinus pressure, and chest congestion. Although fewer visits resulted in steroid or opioid prescriptions, the consequences of such overprescribing include worsening patient health through adverse drug events, increased healthcare costs, hospitalizations, and in the case of antibiotics, the broader threat of antimicrobial resistance [2].

The study included both adults and children, with more than half of the visits made by women. Most people were in their 30s, but the results may not reflect what happens for people with different or no insurance coverage [1].

To address this issue, systemic and cultural changes are needed. Solutions include implementing outpatient stewardship programs focusing on guideline adherence for antibiotics and opioids, using drug management programs to limit opioid overutilization and monitor high-risk patients closely, educating providers on numerical reasoning and social determinants of health, promoting deprescribing initiatives, and encouraging communication between providers and patients [3][5].

Successful mitigation demands shifting from reactive prescribing at the point of care to upstream systemic reforms and cultural shifts that prioritize quality and patient-centered care over medication quantity [1][2][3][4][5]. It is crucial for urgent care clinics to take action to reduce overprescribing and ensure that patients receive the appropriate and necessary care.

[1] Xu J, et al. Overuse of Antibiotics, Opioids, and Steroids in the Urgent Care Setting: A Retrospective Analysis. JAMA Network Open. 2021;4(5):e2111439. doi:10.1001/jamanetworkopen.2021.11439

[2] American Academy of Family Physicians. Overuse of Antibiotics in the Urgent Care Setting. 2021. [online] Available at: https://www.aafp.org/news/health-of-the-public/20210518overuse-of-antibiotics-in-the-urgent-care-setting

[3] Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2019. 2019. [online] Available at: https://www.cdc.gov/drugresistance/threat-report-2019/pdf/ar-threats-2019-508.pdf

[4] National Institute on Drug Abuse. Opioid Overdose Crisis. 2021. [online] Available at: https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis

[5] National Quality Forum. Recommended Practices for Opioid Management in Primary Care. 2019. [online] Available at: https://www.qualityforum.org/Content/NavigationMenu/Topics/MedicationUse/Opioids/RecommendedPracticesforOpioidManagementinPrimaryCare/

1. Urgent care clinics' overprescribing of antibiotics, opioids, and steroids could be a significant contributing factor to the ongoing health crisis.
2. Antibiotics were often prescribed for conditions where they are ineffective, such as certain ear infections, mild bladder symptoms, and common chest colds.
3. Nearly half of the prescriptions for antibiotics did not have a clear justification.
4. Opioids were overprescribed for minor injuries, stomach discomfort, and general muscle pain.
5. This overuse of antibiotics can make bacteria resistant to treatment, potentially leading to stronger, drug-resistant strains spreading in the community.
6. Steroids were overused, especially for coughs, sinus pressure, and chest congestion.
7. Solutions to address this issue include implementing outpatient stewardship programs and promoting deprescribing initiatives.
8. Shifting from reactive prescribing to upstream systemic reforms and patient-centered care is crucial for change.
9. The study involved both adults and children, with more than half of the visits made by women.
10. Most people were in their 30s, but the results may not reflect those of people with different or no insurance coverage.
11. Overprescribing can lead to adverse drug events, increased healthcare costs, hospitalizations, and in the case of antibiotics, the spread of antimicrobial resistance.
12. In the study, fewer visits resulted in steroid or opioid prescriptions; however, the consequences of such overprescribing are severe.
13. The American Academy of Family Physicians addresses the overuse of antibiotics in the urgent care setting.
14. The Centers for Disease Control and Prevention highlights the threat of antibiotic resistance in the United States.
15. The National Institute on Drug Abuse focuses on the opioid overdose crisis.
16. The National Quality Forum recommends practices for opioid management in primary care.
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