Comparison of outpatient antibiotic prescribing in traditional medical, retail clinic settings

Bottom Line: Outpatient antibiotic prescribing varied among traditional medical and retail clinic settings and during visits with respiratory diagnoses where antibiotics were inappropriate, patterns that suggest differences in patient mix and antibiotic overuse.

Why The Research Is Interesting: Antibiotic use contributes to antibiotic resistance, and antibiotic overuse is common, especially for viral respiratory infections. This study compared antibiotic prescribing patterns among urgent care centers, retail clinics, emergency departments and medical offices.

Who and When: Outpatient claims data from a 2014 database that captures claims data on people younger than 65 with employer-sponsored insurance

What (Measures and Outcomes): Outpatient claims at urgent care centers, retail clinics, hospital based-emergency departments or medical offices were each assigned a diagnosis (exposure); percentage of visits linked to prescription of antibiotics with a focus on respiratory diagnoses where antibiotics were unnecessary (outcomes)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Katherine E. Fleming-Dutra, M.D., of the U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, and coauthors

Study Limitations: Researchers could not clinically validate diagnoses in claims data so misclassification was possible, data also are not generalizable to populations not captured in this claims database, and facility codes could not be validated.

Study Conclusions: Antibiotic stewardship, the effort to optimize antibiotic use, across the spectrum of outpatient settings could help to improve antibiotic prescribing and patient care.

Related Material: The patient page, "I Have a Cold – What Do I Need to Know," and the invited commentary, "Overprescription in Urgent Care Clinics – the Fast and the Spurious," by JAMA Internal Medicine Editor Rita F. Redberg, M.D., M.Sc., of the University of California, San Francisco, and coauthors also are available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamainternmed.2018.1632)

Editor's Note: The article contains funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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