Latest news with #urgentcare
Medscape
a day ago
- Health
- Medscape
Urgent Care Linked to High Prescribing Rates
TOPLINE: 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.
BBC News
6 days ago
- Health
- BBC News
'Over-complex' NHS led to man's death, says Cumbria coroner
An "over-complex" NHS system played a "major" role in the death of a 79-year-old man, a coroner has Mallinson died on 23 November at Cumberland Infirmary in Carlisle following a lack of "effective response or treatment" from health services for four days, according to assistant coroner for Cumbria Dr Nicholas said the case was an example of how "over-complexity has lost sight of a man's urgent care needs".The coroner issued a future deaths report on Tuesday, outlining the various treatment delays that Mr Mallinson faced. Dr Shaw said the 79-year-old became unwell on 17 November with vomiting and following day, his wife called to request a GP appointment but was told there were none available that day and to call 111 the 111 call, an ambulance was sent and Mr Mallinson was found to be healthy enough and told to call again if his symptoms persisted. 'Calls never came' Still feeling ill the next day, Mr Mallinson attended a telephone GP appointment and was prescribed anti-diarrhoeal the fourth day, Mr Mallinson continued to get weaker and so his wife called 111 again. She was told he would get a GP appointment the same day and to wait for a call back. Dr Shaw said that call never Mallinson's wife then called 999 just before midnight. She was told by North West Ambulance Service (NWAS) that a doctor from Cumbria Health, the out-of-hours provider, would call back within two Mallinson's wife waited up until 04:00 GMT, but that call also never the fifth day, following a night of "continuous vomiting and diarrhoea", Mr Mallinson's wife called the GP and was offered an afternoon then called 999 again and an ambulance was sent. 'Where does responsibility lie?' Mr Mallinson was taken to hospital immediately, where he was found to have symptoms including hypothermia and failing died in hospital two days later, the coroner said, adding that if Mr Mallinson had received treatment in a "timely manner" he most likely would have Shaw said the GP practice, run by provider SSP Health, had acknowledged Mr Mallinson should have been offered an in-person appointment rather than a telephone also said he understood it was "impossible" for clinicians at Cumbria Health to answer and triage all the calls it received that night, as well as treat their caseloads. He said he was also concerned there was no way for NWAS to know that Mr Mallinson had not been tended to that night. "Where does responsibility lie?" the coroner Shaw said Mr Mallinson's death was an example of what happens when an "over-complex" system failed Health, Cumbria Health, NWAS and the Department for Health and Social Care (DHSC) have 56 days to respond to Dr Shaw's offered its condolences and said it was considering the report. Cumbria Health said it "acknowledged" the coroner's conclusions and was working to ensure his recommendations were met. DHSC and SSP Health have been approached for comment. Follow BBC Cumbria on X, Facebook, Nextdoor and Instagram.
Medscape
7 days ago
- Health
- Medscape
Pneumonia 101: When to Admit and When to Treat Outpatient
This transcript has been edited for clarity. Pneumonias are very commonly encountered diagnoses and something that we see in many patients, whether it is in the outpatient field, in urgent care, or in a hospital. We treat these patients generally based off symptoms, whether they're acute, mild, moderate, or chronic, important for us to check out what type of organism is growing within their sputum. This can help guide us in terms of therapies. We can use different scores, like the pneumonia severity index or the CURB-65, to guide us as to whether a patient needs to be hospitalized or we feel we need to escalate care from oral to [intravenous] antibiotics. Sometimes these patients require hospitalization in the ICU with mechanical ventilation to give them a chance to recover, their lungs to function better, and to help with the mucus and sputum that they are feeling. It's important to remember prevention strategies for our patients, as some of our patients are chronically sick and can get worse with pneumonia. Aspiration precautions are very important. Also, it is important for patients to get vaccinations, such as pneumococcal, [ respiratory syncytial virus], flu, and COVID-19, for which they are indicated. Making sure to counsel our patients on vaccinations can be important and life changing.
CBC
15-07-2025
- Health
- CBC
New urgent-care centre years in development expected to open this fall
Work to turn the former Costco building in St. John's into a new urgent-care centre has been underway for some time, but members of the media got a first-look tour of the facility on Tuesday ahead of a projected opening in the fall. As the CBC's Jessica Singer reports, officials hope it will lessen the burden on overwhelmed emergency rooms.
CBC
15-07-2025
- Health
- CBC
From Costco to clinics: New health-care centre opening in east end of St. John's this fall
A new health-care facility will open in the former Costco building in St. John's in October, offering urgent care and outpatient appointments. People may know it as the former Costco building, but "it looks nothing like that now," Health Minister Krista Lynn Howell told reporters during a tour of the site on Tuesday. Howell said the new urgent- and ambulatory-care centre at 28 Stavanger Drive is opening in phases this fall and is expected to shorten hospital wait times. The urgent care centre will treat people with non-life threatening injuries and illnesses — such as minor sprains and strains. It's meant to relieve pressure on emergency rooms, said Howell, so ERs can focus on "true emergencies." Several outpatient services are also opening at the ambulatory-care centre in October, relocating from the Health Sciences Centre and St. Clare's Mercy Hospital. These include several specialist clinics and two X-ray machines, orthopedics, audiology, and appointment scheduling and registration, said a Newfoundland and Labrador Health Services statement. More services are scheduled to move to the site in December, including physiotherapy, blood collection, occupational therapy, surgery preadmission clinic, pain clinic, ultrasound and an additional X-ray machine. MRI services are set to open in 2026. There will be an information campaign in the fall to let people know where they should go for different health issues, said Greg Browne, a vascular surgeon and the clinical lead for healthcare infrastructure. Once you're inside the building, Howell said clear signs will make it easier for people to know where their appointments are. "I think as patients we're going to really see the benefits of this once we start using it," said Dorothy Senior, a patient advisor who sits on committees for the health authority. She listed the benefits of having access to all clinics in one area, colour coding, and having comfortable places to sit. In its statement, the health authority said the hub will have free parking for patients and staff, as well as an outdoor space. A pharmacy and Jumping Bean coffee shop are set to open there next year, and there are plans underway for a daycare provider. The project is coming in on budget, said Kimberley Pike, clinical planner with Provincial Capital Planning. The province is renting the old Costco site, which hasn't been used since 2019. "Clinic appointments and ambulatory appointments really don't need to happen in an acute care hospital, with all the hustle and bustle and the stress that people go through by going into a hospital environment," said Pike. In its statement, the health authority said some outpatient services will still remain at the hospitals. Ear, nose and throat clinics, as well as rheumatology, will also stay at St. Clare's Mercy Hospital.
