Too Many Antibiotics Prescribed for Inappropriate Diagnoses

Fleming-Dutra

McDonald

Two recent studies on antibiotic use may indicate that antibiotic prescribing could be improving over time. However, there may be additional opportunities to get even better.

A recent CDC study, published in JAMA Internal Medicine, show that there are still important opportunities to improve antibiotic prescribing in urgent care settings, particularly for respiratory illnesses like colds, flu, and bronchitis which should not be treated with antibiotics.

“Antibiotic stewardship, which is the effort to measure and improve antibiotic use, can help reduce unnecessary antibiotic prescriptions and is needed in all outpatient settings, including urgent care,” says Katherine E. Fleming-Dutra, MD, deputy director, Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, CDC.

CDC estimates that at least 30% of outpatient antibiotic prescriptions are unnecessary and many more are inappropriate in antibiotic selection, dosing, and duration.

According to Fleming-Dutra, CDC is actively collaborating with organizations in the urgent care space to identify successes, challenges, and opportunities for improvement related to antibiotic use. “Improving the way healthcare professionals prescribe antibiotics, and the way patients take antibiotics, helps keep us healthy now, helps fight antibiotic resistance, and ensures that life-saving antibiotics will be available for future generations,” she says.

Another study by urgent care EHR provider, DocuTAP, examined antibiotic prescribing trends in four categories: antibiotic usage statistics; appropriate vs. inappropriate antibiotic prescribing; antibiotic-inappropriate prescribing based on respiratory condition; and antibiotic prescribing by region. It looked at every urgent care visit that included an E/M (Evaluation and Management) code from July 1, 2017 through June 30, 2018-which excludes most non-urgent care visits like occupational medicine services, sports physicals, and flu shot visits. Total visits represent the count of unique patient visit IDs.

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DocuTAP determined that antibiotics were inappropriately prescribed in just 6.1% of urgent care visits; and 32.4% of visits to urgent care for respiratory conditions for which antibiotics are ineffective still received prescriptions for antibiotics-13.3% lower than the number reported by the CDC (45.7%).

“Regardless of the reason antibiotic resistance is on the rise, we will do our part as an industry partner to equip urgent care providers with the best technology and resources for effective prescribing practices,” says Eric McDonald, founder and CEO of DocuTAP.

DocuTAP’s research showed that more than half of the urgent care visits included in the study resulted in an antibiotic prescription. Nonsuppurative otitis media was the respiratory condition that resulted in the highest percentage of potential inappropriate antibiotic prescriptions. Both studies found that over 40% of urgent care visits for colds received antibiotics.

McDonald offers these four takeaways about antibiotic prescribing:

• Urgent cares have always been healthcare innovators and I expect the industry will adapt and respond more quickly than other healthcare segments. 
• While we all have work to do when it comes to antibiotic prescribing, this data confirms that the rate at which urgent cares are inappropriately prescribing antibiotics is in line with other segments of the healthcare market.
• It is up to practitioners to be their own watchdogs.
• When patients expect to receive antibiotics, educating them on the risks and providing suggestions for handling the discomfort of respiratory conditions can go a long way to improving antibiotic stewardship.