Study examines overall ARI antibiotic prescribing at clinics
NEW YORK — As a growing fraction of acute respiratory infections visits occur at retail-based health clinics, researchers examined the impact of the shift to such clinics and found that, compared with primary care practices and emergency rooms, there was no difference at retail clinics in overall ARI antibiotic prescribing, according to a study published online in The American Journal of Managed Care.
“In prior studies comparing rates of antibiotic prescribing, little difference was observed between retail clinics and outpatient physician practices; however, these were small studies that used a limited set of diagnoses and health plan claims data,” researchers stated. ”In this study, we compared antibiotic prescribing at retail clinics, primary care practices, and emergency departments (EDs) for all ARIs using national data collected directly from the EHR or the medical chart.”
Researchers found that between 2007 and 2009, there were 3 million, 162 million, and 29 million ARI visits, respectively, at retail clinics, primary care practices, and EDs. There were several notable differences in patient characteristics across the three care sites. Children and adolescents made up a smaller fraction of ARI visits to retail clinics (27%) than to primary care practices (50%) and EDs (43%). A smaller fraction of patients reported a chronic illness at retail clinics (4%) compared with primary care practices (20%) and EDs (22%).
The study also found that the mix of ARI visits varied by site of care. At retail clinics, a higher proportion of ARI visits (53%) led to an antibiotics-may-be-appropriate diagnosis (sinusitis, otitis media, and streptococcal pharyngitis) than at primary care physician offices (32%) and EDs (29%).
“In a large, nationally representative sample of ARI visits, retail clinics had an antibiotic prescribing rate similar to that of primary care practices and EDs. This is reassuring evidence that the shift in care to retail clinics will not negatively impact antibiotic prescribing in the United States. The lack of a difference is consistent with the larger literature, that demonstrates that nurse practitioners and physicians provide care of similar quality,” researchers stated.
According to researchers, ARIs account for 60% of all retail clinic visits. Providers at retail clinics independently manage and prescribe medications. State regulations vary on whether nurse practitioners at retail clinics must maintain a collaborative or supervisory relationship with a physician. Currently, there are almost 6 million yearly visits to the 1,600 retail clinics in the United States, and the number of retail clinics is expected to grow rapidly in the coming years.