Urgent Care Association pushes for more proactive approach to antibiotic stewardship

The Urgent Care Association (UCA) recently launched an advocacy program aimed at curbing inappropriate antibiotic prescribing in urgent care settings.

The rising threat of antibiotic-resistant infections has generated widespread concern about antibiotic prescribing practices. Inappropriate prescriptions have been a particular issue among urgent care clinics, which generate inappropriate prescriptions for respiratory diagnoses at much higher rates than other care settings, according to a recent JAMA Internal Medicine study.

The UCA hopes to address the problem head-on with the Antibiotic Stewardship Commendation program it recently launched in association with the College of Urgent Care Medicine. Urgent care practices have some unique challenges compared to a typical primary care practice, says Joe Toscano, M.D., clinical content adviser for UCA.

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The nature of a patient visit at an urgent care clinic is different from a visit to a primary care physician in a number of ways that potentially complicate antibiotic prescriptions. The biggest of these is the retail nature of the transaction, which blurs the line between a patient and a customer.

“I think patients come in expecting something, like an X-ray or a test or a prescription, which to some extent drives a little higher rate of prescribing compared to other venues,” says Toscano.

He points out that urgent care physicians also provide more episodic care, so it can be more difficult to follow up with a patient a day or two later. In those cases, simply writing a prescription can seem like the most expedient thing to do.

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UCA’s new commendation program uses the Centers for Disease Control and Prevention’s Core Elements of Outpatient Antibiotic Stewardship program as a basic framework for managing the changes necessary to curb unnecessary antibiotic prescriptions. The strategy relies on four key elements:

  • Commitment. UCA features a commitment statement on its website that clinics can sign and display publicly, indicating they understand the problem and have committed to positive change.
  • Action for policy and practice. Toscano says these actions can include appointing a person in the practice to champion antibiotic stewardship and make sure everybody in the practice is on the same page. “If one person is doing one thing and another person’s doing another, it’s harder to effect change than having everybody acting on the same policy basis,” he explains.
  • Data and reporting. Clinics must have a way to set a baseline and measure their improvement. Toscano points out that this activity generates an awareness factor for physicians who might not otherwise know how their prescribing practices stack up against other doctors in the practice or across the country. It also helps identify best practices among those with low prescribing rates.
  • Education and expertise. The last piece involves providing expert guidelines for physicians so they understand not only when to prescribe antibiotics and when not to, but also how to target their prescription to ensure they have the right drug, duration and dosage.

According to Toscano, there’s a broad base of support for improved antibiotic stewardship among urgent care practitioners—they simply may not be aware of how many practitioners share their frustrations about the pressure they’re under to prescribe.

“I don’t think anybody prescribes knowing it’s the wrong thing—but when you see that it’s common among other practitioners and it’s different from other venues, and that other practitioners are similarly frustrated by the sense of pressure to prescribe, that’s what catalyzes it—the awareness of those things coming together, and then the idea that there’s a solution,” he says.