A study led by researchers at the University of Michigan suggests urgent care visits are commonly associated with unnecessary prescribing of antibiotics, opioids, and glucocorticoids.

For the study, which was published yesterday in the Annals of Internal Medicine, the researchers used commercial insurance and Medicare supplemental databases to conduct a cross-sectional analysis of outpatients of all ages with an urgent care place-of-service code from January 2018 through December 2022. Among more than 22.4 million urgent care visits involving more than 10.7 million individuals, they found that 12.1%, 9.1%, and 1.3% of visits resulted in antibiotic, glucocorticoid, and opioid prescription fills, respectively. They then examined the appropriateness of those prescriptions using consensus definitions.

While antibiotics were found to be always appropriate for 58.2% of upper respiratory infections, and 63.9% of urinary tract infection visits, antibiotic prescriptions were frequently filled for patients diagnosed with "never-appropriate" indications. Nearly one-third (30.6%) of patients diagnosed with otitis media (ear infection), 45.7% of those diagnosed genitourinary signs and symptoms, and 15% diagnosed with acute bronchitis received antibiotics. 

Glucocorticoids were considered "generally inappropriate" in 23.9% of sinusitis, 40.8% of acute bronchitis, and 11.9% of upper respiratory cases, while inappropriate opioids were prescribed in 4.6% of musculoskeletal cases, 6.3% of patients with abdominal pain and digestive symptoms, and 4.0% of patients with sprains and strains.

Multifaceted approach needed to address inappropriate prescribing

The findings are unsurprising for antibiotics, given previous research has indicated inappropriate antibiotic prescribing is a problem in urgent care settings. But the study authors say their research indicates the problem extends beyond antibiotics, and reflects issues with clinician knowledge, patient demand, and lack of decision support. They call for future studies to focus on identifying components of urgent care-tailored stewardship programs.

“Reducing inappropriate prescribing of antibiotics, glucocorticoids and opioids will require a multifaceted approach,” study co-author Shirley Cohen-Mekelburg, MD, said in a press release. “Providers at urgent centers would benefit from greater support and feedback in making these decisions.”

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