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Clin Infect Dis. 2019 Oct 23. pii: ciz910. doi: 10.1093/cid/ciz910. [Epub ahead of print]

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

Author information

1
Office of Patient Experience, Intermountain Healthcare, Salt Lake City, Utah, USA.
2
Intermountain Urgent Care, Intermountain Healthcare, Salt Lake City, Utah, USA.
3
Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
4
System Pharmacy Services, Intermountain Healthcare, Salt Lake City, Utah, USA.
5
Intermountain Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah, USA.
6
Office of Research, Intermountain Healthcare, Salt Lake City, Utah, USA.
7
Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
8
Department of Pediatrics, Division of Pediatric Inpatient Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
9
Department of Pediatrics, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA.

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. We describe antibiotic prescribing in a large network of urgent care (UC) clinics. The high volume of infectious diseases encounters and extreme provider variability in antibiotic prescribing frequency and quality highlight the importance of antibiotic stewardship interventions specifically targeting UCs.

KEYWORDS:

antibiotic stewardship; pediatric urgent care; telemedicine; urgent care

PMID:
31641768
DOI:
10.1093/cid/ciz910

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