Article Impact Level: HIGH Data Quality: STRONG Summary of Annals of Internal Medicine, ANNALS-24-04111. https://doi.org/10.7326/ANNALS-24-04111 Dr. Shirley Cohen-Mekelburg et al.
Points
- This cross-sectional study analyzed over 22 million urgent care visits from 2018 to 2022 to evaluate patterns of inappropriate medication prescribing across the United States.
- Antibiotic prescriptions were frequently filled for never-appropriate indications, including 30.66% for otitis media, 45.7% for genitourinary symptoms, and 15.0% for acute bronchitis.
- Glucocorticoids were commonly and inappropriately prescribed for conditions like upper respiratory infections, sinusitis, and acute bronchitis, with a prescription fill rate of 40.8% for the latter.
- Opioid prescriptions were often inappropriately provided for nonback musculoskeletal pain, abdominal pain, and sprains, with fill rates of 4.6%, 6.3%, and 4.0% respectively.
- The findings underscore the urgent need for multifaceted stewardship programs that aim to reduce inappropriate prescribing and mitigate patient harm in urgent care settings across the nation.
Summary
A large-scale, cross-sectional study was conducted to assess inappropriate prescribing practices within urgent care settings. Researchers analyzed outpatient data from Merative, representing over 270 million Americans of all ages with an urgent care place-of-service code, between January 1, 2018, and December 31, 2022. The final cohort included 10,773,218 patients from 22,426,546 urgent care visits. The objective was to quantify the rates of inappropriate antibiotic, glucocorticoid, and opioid prescribing to inform stewardship program development.
The findings revealed that 12.4% of all visits resulted in an antibiotic prescription fill, 9.1% in a glucocorticoid fill, and 1.3% in an opioid fill. For visits concerning upper respiratory and urinary tract infections, antibiotic prescriptions were deemed appropriate in 58.2% and 63.9% of cases, respectively. However, high rates of antibiotic prescribing were observed for never-appropriate indications, including otitis media (30.66%), genitourinary signs and symptoms (45.7%), and acute bronchitis (15.0%). Similarly, glucocorticoid prescriptions were frequently filled for generally inappropriate indications like upper respiratory infections (11.9%), sinusitis (23.9%), and acute bronchitis (40.8%).
Opioid prescription fills were also commonly associated with generally inappropriate indications. These included visits for nonback musculoskeletal pain (4.6%), abdominal pain and digestive symptoms (6.3%), and sprains and strains (4.0%). The authors conclude that urgent care centers continue to be a significant source of inappropriate antibiotic, glucocorticoid, and opioid prescribing. These results underscore the critical need for multifaceted, tailored stewardship programs to curb these practices and reduce the potential for preventable patient harm.
Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-24-04111
References Cohen-Mekelburg, S., Wallace, B. I., Kenney, B., Read, A., Weston, V. C., & Waljee, A. K. (2025). Antibiotic, glucocorticoid, and opioid prescribing in urgent cares: An opportunity for reducing medication overuse. Annals of Internal Medicine, ANNALS-24-04111. https://doi.org/10.7326/ANNALS-24-04111
