Examining Factors That Impact Antibiotic Prescribing in Urgent Care

Prescribing of antibiotics for respiratory concerns in an urgent care setting varied by multiple demographic characteristics, such as patient age and gender, according to a poster presented at IDWeek 2022, held Octobrer 19 to 23 in Washington, DC. These results raise concerns about a lack of health care equity and other inequalities in care.

Researchers looked at urgent care encounters for respiratory conditions in Utah’s Intermountain Healthcare network from July 2018 to June 2019, identified by ICD-10 code. Investigators assessed antibiotic prescribing rates for 3 tiers: 1, antibiotics indicated; 2, antibiotics sometimes indicated; and 3, antibiotics not indicated. Then, they looked at prescribing rates in categories where lack of equity might be possible, such as patient age, weight, race or ethnicity, preferred language, provider type, and provider/patient gender combinations.

Of the 193,107 urgent care visits for respiratory concerns, 93,588 recieved an antibiotic prescription. Overall, antibiotic prescription rates were higher for White patients vs non-White patients (49% vs 38.2%) and in those of non-Hispanic ethnicity vs Hispanic ethnicity (49.1% vs 43.2%). Younger patients were less frequently given antibiotics than those aged 18 years and older.

When evaluating tier 3 concerns, male providers wrote antibiotic prescriptions more frequently for male patients than female providers did for female patients (20.8% vs 15.6). Additionally, patients who were overweight or obese and had tier 3 concerns were prescribed antibiotics more frequently than patients who were not obese or overweight (22.8% vs 15.3%). Language preferences (English vs non-English) showed a minimal difference.

As in previous research, these results indicate differences in prescribing behaviors based on patient characteristics. “These differences may represent biases contributing to inequities in care and may serve as potential targets for improved stewardship efforts,” the authors concluded.

References

1. Seibert AM, Stanfield VK, Fino N, Gwiazdon M, Hersh A, Stenehjem EA. An exploratory analysis to examine urgent care antibiotic prescribing inequities in a vertically integrated healthcare system. Presented at: IDWeek 2022; October 19-23, 2022; Washington, DC. Poster 1739.