Comparison of Antibiotic Prescribing in Retail Clinics, Urgent Care Centers, Emergency Departments, and Traditional Ambulatory Care Settings in the United States

Abstract

Emergency Departments, and Traditional Ambulatory Care Settings in the United StatesAntibiotic use contributes to antibiotic resistance and is associated with adverse events, including Clostridium difficile infections. 1 Antibiotic overuse, especially for viral respiratory infections, is common. 2Only 60% of outpatient antibiotic prescriptions dispensed in the United States are written in traditional ambulatory care settings (hereinafter "medical offices") and emergency departments (EDs). 2 Growing markets, including urgent care centers and retail clinics, may contribute to the remaining 40%. 3,4Our objective was to compare antibiotic prescribing among urgent care centers, retail clinics, EDs, and medical offices.Methods | We conducted a retrospective cohort study using the 2014 Truven Health MarketScan Commercial Claims and Encounters Database, which captures claims data on individuals younger than 65 years with employer-sponsored insurance. 5he National Center for Emerging and Zoonotic Infectious Diseases human subjects advisor deemed these to be deidentified data and thus exempt from ethical approval and patient written informed consent.Outpatient claims with facility codes for urgent care center, retail clinic, hospital-based ED, or medical office were included.We included all visits for which medical and prescription coverage data were captured for the months of, prior to, and following the visit (except December 2014 visits).We excluded visits for which diagnoses were missing or for patients with recent hospitalizations or recent outpatient systemic antibiotic prescription fills.Each visit was assigned a single diagnosis using a previously described, tiered system of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. 2 Data on systemic (oral and parenteral) antibiotic prescriptions, identified using national drug codes from the 2016 Truven Health Red Book supplement, were extracted from outpatient pharmaceutical claims.Oral antibiotic prescriptions were linked to each enrollee's most recent outpatient visit within 3 days. 6Parenteral antibiotics were linked to same-day outpatient visits.The unit of analysis was unique visits, and the outcome was percentage of visits linked to prescription of antibiotics, stratified by setting and diagnosis.We focused on antibiotic-inappropriate respiratory diagnoses (ie, diagnoses for which antibiotics are