Antibiotic Prescribing Variability in a Large Urgent Care Network: A New Target for Outpatient Stewardship

Abstract

Improving antibiotic prescribing in outpatient settings is a public health priority. In the United States, urgent care (UC) encounters are increasing and have high rates of inappropriate antibiotic prescribing. Our objective was to characterize antibiotic prescribing practices during UC encounters, with a focus on respiratory tract conditions. This was a retrospective cohort study of UC encounters in the Intermountain Healthcare network. Among 1.16 million UC encounters, antibiotics were prescribed during 34% of UC encounters and respiratory conditions accounted for 61% of all antibiotics prescribed. Of respiratory encounters, 50% resulted in antibiotic prescriptions, yet the variability at the level of the provider ranged from 3% to 94%. Similar variability between providers was observed for respiratory conditions where antibiotics were not indicated and in first-line antibiotic selection for sinusitis, otitis media, and pharyngitis. These findings support the importance of developing antibiotic stewardship interventions specifically targeting UC settings.

Keywords: antibiotic stewardship; pediatric urgent care; telemedicine; urgent care.

Figure 1.

Flow chart illustrating criteria used to exclude selected urgent care encounters to derive final study data set.

Figure 2.

The percentages of urgent care encounters for respiratory conditions with an antibiotic prescription, by (A) individual clinics and (B) individual providers. Data represent 39 total clinic sites (32 InstaCare [all ages], 6 KidsCare [<18 years], and 1 Connect Care [telemedicine]) and 396 providers. Respiratory conditions are defined in the Supplementary Appendix. The vertical lines represent 95% confidence intervals (CIs).