By the bioMérieux Connection Editors
During the healthcare reform debate of a decade ago, urgent care and other innovative patient access ideas, like the retail clinics seen in many chain grocery and pharmacies today, were promoted as a cost-effective alternative to primary care at a time when the nation’s medical schools were graduating fewer and fewer primary care physicians. The combination of fewer primary care physicians and the lack of health insurance was driving a very costly trend in the U.S.—the use of emergency departments for primary care.
As a result, urgent care medicine experienced “meteoric growth” across the U.S. over the last decade, according to the Urgent Care Association (UCA). Since 2014, the number of clinics has increased by nearly 20 percent, from 6,400 clinics in 2014 to 7,639 in 2017. The UCA forecasts a 5.8 percent growth in 2018, bringing the total to approximately 8,000 clinics by year’s end.
Approximately 20 percent of all primary care visits now occur at urgent care clinics, according to UCA data. In 2013, urgent care centers saw 491 million primary care patients, which accounted for 18.2 percent of all primary care visits in the U.S. and 9.7 percent of all outpatient physician visits.
But, as primary care has shifted from the doctor’s office to convenient quick clinics, antibiotic overuse has increased. In a recent JAMA study, researchers found that half of patients who go to urgent care facilities for cold, flu, or other respiratory conditions that cannot be treated with antibiotics are, nonetheless, prescribed antibiotics. In fact, urgent care clinics are 3 times more likely to dispense antibiotics than the traditional general practitioner.
The unnecessary exposure to antibiotics puts patients at risk for adverse reactions, such as antibiotic allergies, organ injury and damage, and opportunistic infections like C. difficile. Additionally, the undisciplined use of vital antibiotics puts us all—but particularly the most vulnerable populations like the elderly and young children—at risk for antibiotic resistant infections.
According to the Centers for Disease Control and Prevention (CDC), “30 percent of antibiotics, or 47 million prescriptions annually, are prescribed unnecessarily in doctors’ offices and emergency departments in the United States… Antibiotics are overprescribed in both human and animal settings, which makes everyone less safe.”
According to the JAMA study, the rate of overprescribing is much higher in urgent care facilities than doctors’ offices and emergency departments. The researchers focused on respiratory conditions, including influenza, colds, bronchitis, and pneumonia, which are predominately caused by viral infections, not bacteria. They also included allergies and asthma exacerbation, which are not caused by infections at all. Collectively, those respiratory conditions are the most likely to be mistreated with antibiotics.
While urgent care clinics have improved access to healthcare for patients, with increased convenience, evening and weekend hours, and lower out-of-pocket costs, a very dangerous and unintended cost has emerged: antibiotic overuse. While patients with respiratory conditions often request—or even demand—antibiotics, urgent care clinics are far more likely to comply than primary care physicians, the study found.
Opinions expressed in this article are not necessarily those of bioMérieux, Inc.