Urgent Care Linked to High Prescribing Rates
Urgent care visits frequently result in inappropriate prescribing, with 12.4% leading to antibiotic fills, 9.1% to glucocorticoid fills, and 1.3% to opioid fills. Analysis of over 22.4 million urgent care visits revealed concerning patterns, including 40.8% of acute bronchitis visits resulting in inappropriate glucocorticoid prescriptions.
METHODOLOGY:
Researchers conducted a cross-sectional study analyzing urgent care visits from January 1, 2018, to December 31, 2022, using Merative MarketScan Commercial and Medicare Supplemental databases representing over 270 million Americans and 12.9 million Medicare supplemental beneficiaries.
Analysis included 10,773,218 patients with a median age of 34 years (interquartile range, 20-49 years), with 56.6% (n = 8,640,819) being women, from a total of 22,426,546 urgent care visits.
Primary diagnosis codes were grouped into Clinical Classifications Software Refined (CCSR) categories, with visits containing missing or multiple primary diagnostic codes excluded to ensure accurate assessment of prescription appropriateness.
Patients could contribute multiple visits only when separated by more than 3 days to allow accurate prescription attribution, with researchers examining inappropriate oral antibiotic, glucocorticoid, and opioid prescription fills for the 10 most common CCSR categories.
TAKEAWAY:
Analysis revealed that out of 22,426,546 urgent care visits, 2,783,924 (12.4%) led to antibiotic prescription fills, 2,038,506 (9.1%) to glucocorticoid fills, and 299,210 (1.3%) to opioid prescription fills.
Researchers found that antibiotics were always appropriate for 58.2% (n = 169,782) of upper respiratory infections and 63.9% (n = 325,632) of urinary tract infections, while being frequently filled for never-appropriate indications including otitis media (30.66%, n = 33,001).
Glucocorticoid prescriptions were commonly prescribed, though generally inappropriate for upper respiratory infections (11.9%, n = 306,658), sinusitis (23.9%, n = 253,513), and acute bronchitis (40.8%, n = 190,302).
According to the findings, opioid prescriptions, while generally inappropriate, were common for nonback musculoskeletal pain (4.6%, n = 28,048), abdominal pain and digestive symptoms (6.3%, n = 26,143), and sprains and strains (4.0%, n = 18,806).
IN PRACTICE:
'Inappropriate prescribing in urgent care is influenced by clinician knowledge, patient demands, and lack of decision support. Antibiotic, glucocorticoid, and opioid stewardship programs are needed to reduce inappropriate urgent care prescribing and support long-term glucocorticoid and opioid deprescribing efforts,' wrote the authors of the study.
SOURCE:
The study was led by Shirley Cohen-Mekelburg, MD, MS, Division of Gastroenterology and Hepatology and Institute for Healthcare Policy and Innovation, University of Michigan in Ann Arbor, Michigan. It was published online on July 21 in Annals of Internal Medicine.
LIMITATIONS:
The study population was limited to insured patients, which may affect the generalizability of the findings. The analysis was restricted to the most common CCSR categories associated with each drug type, potentially underestimating the extent of inappropriate prescribing. Additionally, the researchers noted that the limitations of administrative data prevented them from elucidating demographic, clinician, or facility details or confirming medication administration.
DISCLOSURES:
The University of Michigan Institutional Review Board (HUM00127665) deemed this study exempt. Disclosure forms are available with the article online.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Yahoo
25 minutes ago
- Yahoo
2 dead and 58 sick from growing Legionnaires' disease cluster in New York City
Two people have died and at least 58 people have been diagnosed with Legionnaires' disease in a cluster that broke out in the Harlem area of New York City last week, officials said on Monday. The New York City Health Department had reported on Thursday that one person had died and 22 people were sick in the cluster. MORE: 1 dead and at least 22 sick from Legionnaires' disease cluster in New York City 'People living or working in the area with flu-like symptoms, such as cough, fever, chills, muscle aches, or difficulty breathing should contact a health care provider immediately,' the department said in a statement on Monday. 'It is especially important for people at higher risk -- including those ages 50 and older, cigarette smokers, and people with chronic lung disease or compromised immune systems -- to get care if they have symptoms.' Legionnaires' disease is a type of pneumonia that is caused by the bacteria Legionella, which grows in warm water, health officials said, and people can get Legionnaires' disease by breathing in water vapor that contains Legionella bacteria. MORE: Teen suffers 'significant thermal burns' near Yellowstone geyser MORE: Man sentenced to time served for trying to open plane door, stab flight attendant in neck "Anyone in these zip codes with flu-like symptoms should contact a health care provider as soon as possible," said Acting Health Commissioner Dr. Michelle Morse. "Legionnaires' disease can be effectively treated if diagnosed early, but New Yorkers at higher risk, like adults aged 50 and older and those who smoke or have chronic lung conditions, should be especially mindful of their symptoms and seek care as soon as symptoms begin." Legionnaires' disease can be caused by plumbing systems where conditions are favorable for Legionella growth, such as cooling towers, whirlpool spas, hot tubs, humidifiers, hot water tanks and evaporative condensers of large air-conditioning systems, health officials said. People can get Legionnaires' disease by breathing in water vapor that contains Legionella bacteria, though officials reminded people that the disease cannot be transmitted from person to person and can be treated with antibiotics. MORE: Cocaine worth more than $1 million seized at Texas border, CPB says The respiratory disease takes its name from an outbreak at the Pennsylvania American Legion convention held at the Bellevue-Stratford Hotel in Philadelphia in July 1976 and the bacterium believed to be responsible is found in soil and grows in water, such as air-conditioning ducts, storage tanks and rivers. No details about the two people who died have been released by officials as of Tuesday. Solve the daily Crossword
Yahoo
25 minutes ago
- Yahoo
Purespring Therapeutics receives UK CTA approval for Phase I/II clinical trial of PS-002 in patients with primary IgA nephropathy (IgAN)
First patient in Phase I/II clinical trial expected to be enrolled in Q4 2025 UK Clinical Trial Application (CTA) approval shortly follows U.S. IND clearance and granting of European Medicine Agency (EMA) orphan drug designation, enabling readiness for initiation across sites in both the U.S. and Europe PS-002, Purespring's lead precision nephrology programme, targets the complement pathway known to be a driver of IgA nephropathy and is supported by a wealth of preclinical data London – 5 August 2025 - Purespring Therapeutics, a precision nephrology company focused on transforming the treatment of kidney diseases, today announces that its UK Clinical Trial Application (CTA) for a planned Phase I/II study of PS-002, Purespring's lead programme, in patients with IgA nephropathy (IgAN) has been approved by the UK Medicines and Healthcare products Regulatory Agency (MHRA), the NHS Health Research Authority (HRA) and Research Ethics Committee (REC). 'The CTA approval for our Phase I/II clinical trial of PS-002 represents another key milestone as we complete our transition to a clinical-stage precision nephrology company,' said Haseeb Ahmad, Purespring's Chief Executive Officer. 'Building on the recent FDA IND clearance and EMA orphan drug designation, this further validates the potential of our podocyte-targeting approach to go beyond symptom management and directly target kidney disease at its source. Looking ahead, we are committed to working closely with regulators and sites across the U.S. and Europe with the view to expand the therapeutic options available for people living with IgAN.' PS-002 was developed to target the underlying cause of many kidney diseases by modulating complement activation in the kidney via precision targeting of podocytes. The programme is initially focused on the treatment of IgA nephropathy (IgAN), a rare and chronic autoimmune kidney disease that primarily affects young adults. In IgAN, aberrant immunoglobin A (IgA) protein becomes trapped in the kidney's filters, known as the glomeruli, causing complement activation, inflammation, damage and scarring. A significant proportion of affected patients will go on to develop kidney failure despite currently available therapies. The Phase I/II clinical trial, which is expected to enroll its first patient in Q4 2025, will evaluate local administration of PS-002 to treat IgAN. In the Phase 1 part of the Phase I/II study, the main read-outs will be safety parameters, which, together with efficacy biomarkers, will be leveraged to select a dose for the Phase 2 part of the study. This second phase will be used to further define the safety profile and provide early markers of efficacy. Enabled by this latest regulatory approval and the recent U.S. IND clearance, as announced in July 2025, the Phase I/II study will recruit patients across the U.S. and Europe. For further information, contact: Purespring: Peter Mulcahycontact@ (0)20 3855 6324LinkedIn ICR Healthcare Amber Fennell, Sarah Elton-Farrpurespring@ Notes to Editors About Purespring Purespring is developing therapies to halt or prevent kidney disease, one of humankind's most poorly treated disease areas. Founded on the work of Professor Moin Saleem, Professor of Paediatric Renal Medicine at the University of Bristol, Purespring is the first company to successfully treat kidney disease by targeting the podocyte, a specialised cell that is implicated in the majority of renal disease. Purespring's platform approach enables streamlined gene therapy development for both acquired and genetic renal diseases, offering the potential to halt, reverse and even cure both rare and common kidney diseases. The Company currently has a pipeline of programmes in development including the lead asset for treatment of IgA Nephropathy (IgAN) and other complement mediated kidney disease. The Company also has programmes for disease caused by mutations in the gene NPHS2, as well as other monogenic glomerular kidney diseases. Based in London, the Purespring team combines world-leading expertise in podocyte biology and kidney disease with a wealth of experience in gene therapies, anchored in a culture of diversity, creativity and delivery. Purespring is backed by leading biotech investors, including Syncona Limited, Sofinnova Partners, Gilde Healthcare, Forbion, and the British Business Bank and has raised £115m ($149m) to date. For more information please visit: and follow us on in to access your portfolio
Medscape
26 minutes ago
- Medscape
How Social Determinants of Health Affect Patient Care
SEATTLE — Social determinants of health, nonmedical factors that can have a significant influence on health and lead to various disparities in a variety of ways, affect the well-being of patients across every discipline of medicine, including dermatology. In a discussion held during the Society for Pediatric Dermatology (SPD) 2025 Annual Meeting, Sarah Coates, MD, assistant clinical professor of dermatology at the University of California, San Francisco, highlighted the importance of these issues in the care of pediatric patients in dermatology. Providers, including dermatologists, should consider social risks, cost, and health literacy when formulating patient-centered care plans for children, she said. Illustrating how nonmedical factors can have a profound impact on dermatologic health and lead to disparities in care, Coates presented a case study of a 10-month-old boy with atopic dermatitis, whose parents were evicted from their home after losing a job. 'They are living in an emergency shelter with two other children with no access to privacy, a bathtub, and laundry facilities.' The family had been back and forth to urgent care and the emergency department for the child's frequent infections, were often late for their visits because of transportation difficulties, and could not afford over-the-counter (OTC) treatments. 'You only have 15 minutes, and you're in a teaching clinic — your trainee comes out of the room and tells you this, and of course you're feeling heartbroken and overwhelmed,' Coates said. 'How do you care for people in challenging situations? Standard social history does not cover social drivers of health, so how can we move forward?' Social determinants of health include factors such as access to care, the patient's neighborhood, social access, and economic stability, and 'are more important than anything we say to a patient when talking to them one-on-one,' she explained. 'The standard social history we learn in medical school doesn't address this,' she added. Clinicians often lack the tools to address these factors and may feel powerless as a result. 'But I would argue that this is very important and not just for primary care doctors but for us,' she emphasized. 'If we can recognize what is going on in our patients lives, we can have a better relationship with them, and we can improve their adherence to treatment plans. It can improve our burnout and our sense of meaningful work and importantly, recognize health disparities and improve health equity.' Interventions To start, dermatologists can use the first 'three As' of the National Academies of Sciences, Engineering, and Medicine framework at the point of care to identify and address social needs related to their patients: Awareness: Identify the social risks and assets of the defined patients and population. Adjustment: Alter clinical care to accommodate identified social barriers. Assistance: Reduce social risk by providing assistance in connecting patients with relevant social care resources. 'We do know that there are social determinants that contribute to more severe cases of atopic dermatitis,' Coates said. 'These include lower socioeconomic status, single-mother households, lower parental education, poor parental health, and dilapidated housing.' There are practical recommendations that can be provided to help families care for their child. The first is to address challenges such as unaffordable medications. Paying for OTC products, for example, can be difficult. 'Copays do not cover emollients, and Medicaid formularies in only three states cover bland emollients,' Coates noted, adding that families can spend from $35 to almost $320 a month on these products. Cost varies considerably by brand. Recommending store brands of emollients, such as Walgreens, which are cheaper than name brands, can help, she noted. Health literacy is another issue. Low health literacy is associated with reduced adherence, increased emergency visits, and poor outcomes. 'Start by explaining things simply and avoid medical jargon,' such as using the terms 'topical' and 'systemic,' she advised. Instead, she said, atopic dermatitis can be explained by saying, 'Your child has an itchy rash called eczema. This makes the skin red, dry, and scaly. We cannot make it go away and stay away forever, but we have creams that can heal it. If these don't work, we can try medicines that go throughout the entire body.'
