Why do Patients Visit Urgent Cares?
Think about the last time that you went to an urgent care or a same-day care facility to get treatment for a sudden health condition. Whether it took a couple hours or a couple minutes to be seen by a healthcare professional, the idea of receiving care on the same day makes these outpatient care providers more enticing for patients. This is especially true when the wait times for getting an appointment to visit a healthcare professional average around 38 days when the ideal benchmark is 14 days (Association of Healthcare Journalists, 2024). Hence, many acutely developing medical conditions especially those relating to acute respiratory conditions are one of the leading reasons that patients visit urgent cares (Rosenberg, 2018). For these acute respiratory infections, clinicians were more likely to prescribe antibiotics when these drugs are typically rarely prescribed for those symptoms (The Pew Charitable Trusts, 2017).
Current Trends in Antibiotic Prescriptions
60% of antibiotics are prescribed in traditional medical offices and emergency room departments with the remaining 40% prescribed in other settings like urgent care centers and retail clinics. Previously, studies have found that over 30% of antibiotic prescriptions in physician offices and emergency departments were unnecessary, equaling to around 80 million prescriptions per year with no appropriate justification for being prescribed to the patients (JAMA Internal Medicine, 2018). Current studies, now suggest the concerning reality that this number might be higher than the estimated 30% due to inappropriate respiratory diagnoses being the highest in urgent care centers.
What are the Consequences of Overprescribing Antibiotics?
Antibiotics are crucial aids in treating bacterial infections of varying intensities but overusing them can lead to worse adverse health as well as economic effects. Antibiotic resistance develops when patients use antibiotics when they are not indicated for their health condition. This causes bacteria to develop defenses against the treatments built to kill them (National Foundation for Infectious Diseases, 2024). This causes antibiotic resistant bacteria to take over and cause a cascade of infections, such as Clostridium difficile (C. diff) leading to around 48,000 deaths each year (National Foundation for Infectious Diseases, 2024). Methicillin-resistant Staphylococcus aureus (MRSA) also kills more Americans every year than emphysema, HIV/AIDS, Parkinson’s disease and homicide combined, totaling to around 19,000 deaths (Infectious Diseases Society of America, 2011). Antibiotic resistant infections can also lead to extended hospital stays making it costly to be treated by patients that are affected (National Foundation for Infectious Diseases, 2024).
Why do Medical Providers Overprescribe?
Studies have found that medical prescribers value patient satisfaction a lot and hence this is often seen as the driver for overprescription of antibiotics (The Pew Charitable Trusts, 2017). Due to this, prescribers feel the urge to cater to the expectations of patients receiving a prescription. Physicians also have limited time to see patients within an urgent care or same-day care setting, hence increasing their workload and pressures to diagnose patients accurately. This time constraint also pressurizes physicians to reach a less accurate diagnosis, ultimately prescribing antibiotics that are not needed for viral infections. The similarity in symptoms for bacterial and viral infections also leads to misdiagnosis. All these factors lead to “decision fatigue” which is a decline in the decision-making abilities of healthcare providers who make repeated decisions (The Pew Charitable Trusts, 2017).
How to Change This Trajectory of the Medical Intervention System
Antibiotic stewardship programs are being incorporated within various healthcare settings as interventions to reduce overprescription of antibiotics. These stewardship programs enable physicians to engage in better communication strategies with their patients. These stewardship programs also encourage the education of strategies to inform the public and physicians about the consequences of inappropriate antibiotic prescriptions (Infectious Diseases Society of America, 2011). Patients also play a crucial role in reducing the overprescription of antibiotics: by increasing public education regarding antibiotic resistance, patients can question their medical providers regarding their prescriptions, ultimately cross-checking their providers’ reasoning for antibiotic prescriptions. Through this manner, we can decrease antibiotic resistance by addressing the consequences of their overuse, building healthier local and global communities while making same-day care options safer.
Written by Vijayashree Ramamurthy Gayathri and edited by Aldrin V. Gomes, Ph.D.
References
Palms DL, Hicks LA, Bartoces M, et al. Comparison of Antibiotic Prescribing in Retail Clinics, Urgent Care Centers, Emergency Departments, and Traditional Ambulatory Care Settings in the United States. JAMA Intern Med. 2018;178(9):1267–1269. doi:10.1001/jamainternmed.2018.1632
Centers for Disease Control. “Core Elements of Hospital Antibiotic Stewardship Programs” 2019, https://www.cdc.gov/antibiotic-use/hcp/core-elements/hospital.html#toc
Pew Trusts. “What Drives Inappropriate Antibiotic Use in Outpatient Care?” 2017, https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2017/06/what-drives-inappropriate-antibiotic-use-in-outpatient-care
American Journal of Managed Care. “Urgent Care Centers Often Prescribe Unnecessary Antibiotics” 2018, https://www.ajmc.com/view/urgent-care-centers-often-prescribe-unnecessary-antibiotics
National Foundation for Infectious Diseases. “Antibiotic Resistance” 2024, https://www.nfid.org/antibiotic-resistance/
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Association of Health Care Journalists, “In the U.S., wait times to see a doctor can be agonizingly long” 2024, https://healthjournalism.org/blog/2024/08/in-the-u-s-wait-times-to-see-a-doctor-can-be-agonizingly-long/
Infectious Diseases Society of America (IDSA); Spellberg B, Blaser M, Guidos RJ, Boucher HW, Bradley JS, Eisenstein BI, Gerding D, Lynfield R, Reller LB, Rex J, Schwartz D, Septimus E, Tenover FC, Gilbert DN. Combating antimicrobial resistance: policy recommendations to save lives. Clin Infect Dis. 2011 May;52 Suppl 5(Suppl 5):S397-428. doi: 10.1093/cid/cir153. PMID: 21474585.
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