How Many Emergency Clinics Monitor and Control the Prescribing of Antibiotics? (Photo by Joe Amon / The Denver Post about Getty Images)
But a team from Centers for Disease Control and Prevention (CDC) of the University of Utah and The Pew Charitable Trusts analyzed data on insurance claims and found that even if patients were in urgent need of clinics for reasons that did not require antibiotics, 46% of patients were treated Time antibiotics were prescribed
46%, Pew. These are many inappropriate and unnecessary antibiotics
The results of this analysis appear in a research letter, published in JAMA Internal Medicine The team consisted of Danielle L. Palms, MPH, Lauri A. Hicks, DO, Monina Bartoces, PhD and Katherine E. Fleming-Dutra, MD of the CDC, Adam L. Hersh, MD, PhD of the Universit y of Utah, and Rachel Zetts, MPH and David Y. Hyun, MD of The Pew Charitable Trusts. The medical and pharmaceutical data comes from the 2014 Truven Health Analytics MarketScan Claims and Encounter Database, which consists of people under the age of 65 who have employer-sponsored health insurance.
Here is a table of some key analysis results:
(Image courtesy of Amelia Murphy / The Pew Charitable Trusts) The Pew Charitable Trusts
As you can see, office Clinics, retail clinics, emergency rooms, and emergency clinics have prescribed a whole lot of inappropriate antibiotics, otherwise known and over-prescribed antibiotics, otherwise known as "come on, stop trying to use rockets when trying to get rid of a housefly." Emergency clinics, however, are the worst of the 4 settings.
And we're not talking about a few extra recipes here. Of the 2.7 million emergency treatments in the database, 39% resulted in antibiotic prescriptions and 17% in antibiotic-specific airway diagnoses.
Yes, the study has its limits. It is a sample of urgent care clinic visits and not all visits. Not everyone has employer-sponsored insurance. Not everyone is under 65 years old. Claims data do not always fully reflect what happens in the clinics in real life. It shows which insurance codes the doctor enters when he sees a patient. However, the big picture is that doctors in emergency clinics seem to prescribe too many antibiotics.
You could say that doctors in emergency clinics prescribe antibiotics, like sweets, but you should not really give that much sweets either. Too many unnecessary antibiotics can lead to the proliferation of antibiotic-resistant bacteria, making the available antibiotic product less and less useful if you really need antibiotics to save your life. I have already written in Forbes that our society ran out of antibiotics and how super-spooky, Thanos-like, untreatable bacterial strains have arisen due to overuse of antibiotics.
This analysis shows that emergency outpatient services can be a large and overlooked source of inappropriate antibiotic prescriptions. As more and more hospitals and continuity clinics (ie clinics where patients visit their regular doctors) have specialists and programs that try to monitor and control the prescribing of antibiotics, it is not clear how many emergency clinics are doing so. Going to an emergency clinic can be like playing doctor and nurse craps, the casino game and not the toilet. They do not know who you will see and what their experience, references and practice patterns may be.
In addition, a doctor or nurse who only briefly sees you and sees many other patients may be more inclined to treat you with antibiotics. It may seem faster and safer, just to blast you with antibiotics just in case you have an infection that needs antibiotics. Exposing to an infection that requires antibiotics costs time and effort. To miss something like an infection, even if it is unlikely that it could lead to a poor outcome or litigation, should definitely be avoided by someone working in an emergency clinic.
You can also go to an emergency clinic that expects the doctor or a practicing nurse to do something with what in our "quick-fix" society means we often give you a pill. Just being told to get calm and fluid can look like you can not do anything, even if it's right.
With more and more antibiotic-resistant microbes emerging and spreading and a lack of enough new antibiotics to reduce inappropriate antibiotics use is an urgent problem. This latest study shows that it is also an urgent problem in the nursing clinic.