Rebecca Pifer
July 18, 2018
Dive
Brief:
- Among
patients who visited urgent care centers for antibiotic-inappropriate
respiratory problems like bronchitis, flu or asthma, nearly half
(45.7%) were incorrectly prescribed antibiotics, according to a CDC-funded study analyzing
2014 data.
- Incorrect
prescribing was prevalent in other outpatient settings as well, including
emergency departments (24.6% of cases) and traditional ambulatory care
settings like medical offices (17%) and retail clinics (14.4%).
- The results call into question the
past finding that 30% of
outpatient antibiotic prescriptions in the U.S. are unnecessary, equaling
about 47 million prescriptions each
year. Experts now think the number may be higher.
Dive
Insight:
Public
health officials have been sounding the alarm about antibiotic overuse and
abuse for years and overprescribing is a major contributor to antibiotic
resistance, resulting in resistant strains of bacteria known as superbugs.
The
CDC study found substantial variability in prescribing practices across
settings.
Antibiotics
were prescribed in 39% of urgent care center visits, 36.4% of retail clinic
visits, 13.8% of ED visits, and 7.1% of medical office visits in 2014. Patients
sought care for respiratory problems not mitigable by antibiotics in 17% of
retail visits, 16% of urgent care visits, 6% of medical office visits and 5% of
ED visits.
This
variability suggests “differences in case mix and evidence of antibiotic
overuse, especially in urgent care centers,” according to the study’s authors.
Out
of an estimated annual antibiotic prescription rate of 506 per 1,000 people in
the U.S. in 2010, just 353 prescriptions were appropriate. That
study also found that acute respiratory infections are the main source of
inappropriate prescribing and the least likely to receive recommended
treatment.
“Doctors
often prescribe antibiotics even when they know they’re not indicated for many
reasons,” said Katherine Fleming-Dutra, a medical epidemiologist with the
office of antibiotic stewardship in the division of healthcare quality
promotion at the CDC.
“One
of the reasons we hear quite commonly is that doctors are worried about patient
satisfaction and patient demand for antibiotics. Previous studies have shown
that when doctors perceive the patient wants or expects an antibiotic, they’re
more likely to prescribe an antibiotic," she said, adding that they
may fear losing patients to competitors.
Although
traditional medical offices and EDs still prescribe 60% of antibiotics in the
U.S., a growing number of
convenience care clinics (including urgent care centers and retail clinics) make up the remaining 40% of
prescriptions.
The
popularity of such clinics continues to climb in today’s quick-fix, instant
gratification world. The first retail clinics opened around 2000, and by 2010
they numbered just over 1,300, according to RAND. By 2016, there were almost 2,800 — most being used by young
adults, who account for 43% of patients.
The
study’s findings highlight a problem amid this consistent market growth, but
there are potential solutions. Antibiotic stewardship interventions are needed
to reduce unnecessary antibiotic prescriptions across all settings, and now
experts know to focus especially on urgent care centers in their reform
efforts.
The
National Action Plan for Combating Antibiotic-Resistant Bacteria, a
CDC-compiled set of goals and outcomes, set a goal of reducing inappropriate
antibiotic use by 50% by 2020, and antibiotic stewardship efforts are in place
to further the initiative.
“We
have seen some improvements,” Fleming-Dutra said. “In particular we’ve seen
reductions in outpatient antibiotic prescribing from 2011 to 2015,” where the rates decreased by 4% overall. That
was primarily driven by prescribing rates for children, which decreased by 13%
in that time span.
Fleming-Dutra
credited the decline to educational efforts, CDC and outpatient collaboration
and the prevalence of vaccines that reduce diseases that could necessitate
antibiotics later in life.
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