Salt Lake City, UT -- (ReleaseWire) -- 11/19/2019 -- If you're sick but not in dire straits, where do you go when your doctor's office is closed? For a lot of people, the answer is increasingly a nearby urgent care clinic. Nationally, urgent care clinics have been identified as a setting where antibiotics are more likely to be prescribed inappropriately when compared to other outpatient settings.
Unfortunately, the consequences of this are more cases of harmful drug side effects - and the acceleration of antibiotic resistance.
To help combat this growing problem, the Centers for Disease Control and Prevention has awarded Intermountain Healthcare and University of Utah Health a $1.8 million contract to implement a first-of-its-kind antibiotic stewardship best practices initiative across Intermountain's urgent care network.
"Urgent care has never really been a focus of antibiotic stewardship or best practices," said Eddie Stenehjem, MD MSc, medical director of antibiotic stewardship at Intermountain Healthcare. "As we move into a new era of more people using urgent care facilities, it's vital that we do everything we can not to overprescribe to the point that we're harming patients and contributing to antibiotic resistance."
Intermountain's Stewardship in Community Outpatient Settings – Resources and Engagement- Urgent Care (SCORE-UC) initiative is based on the CDC's Core Elements of Outpatient Antibiotic Stewardship and is an extension of prior inpatient antibiotic stewardship efforts.
Like the previous work, there is a physician leader responsible for program outcomes, and a pharmacist leader responsible for working to improve and monitor antibiotic prescribing and use. There is also a service line leader responsible for engaging urgent care physicians and reviewing their performance with them using pre-defined stewardship metrics.
This program focuses on antibiotic prescriptions for respiratory infections at Intermountain Healthcare's 39 clinics, both rural and urban – 32 InstaCare, 6 KidsCare, and 1 ConnectCare, which is a telemedicine platform (or "virtual") clinic.
The initiative is the result of research studies between the CDC, a team from the U of U Health led by Adam Hersh MD, a professor of pediatrics at the U, and Intermountain infectious disease clnicians, urgent care providers and patients.
"This work reflects Intermountain's commitment to quality, safety, and patient experience, said Dr. Stenehjem. "It also represents an important collaboration between Intermountain and University of Utah Health where both organizations are committed to improving antibiotic use."
The focus is on urgent care because it's playing a larger role in healthcare delivery in Utah and throughout the United States. Intermountain currently has 700,000 urgent care visits per year. Between 2008 and 2015, visits for low-acuity care jumped 140% in these treatment settings, while visits to emergency departments dropped by 36% in the same time period.
With this new program clinicians will be able to monitor prescription rates for conditions such as sinusitis, ear infections and bronchitis, while implementing the CDC best practices.
Researchers will then be able to compare how the interventions affect prescription rates and compare them to data collected between August 1, 2017 and July 30, 2018, that looked at 155,712 visits due to respiratory conditions at Intermountain urgent care facilities.
In a recently published study in Clinical Infectious Diseases, a research team led by Drs. Stenehjem and Hersh found significant variability in the 2017-2018 prescribing rates for respiratory conditions by clinician, ranging from 15% of patients receiving an antibiotic to 97%. While this analysis didn't identify if those prescriptions were appropriate, the differences between practices are notable.
"This is an incredible range of variation that we're seeing in our urgent care network, which highlights that this is an area to target for improvement," Dr. Stenehjem said.
Inappropriate prescribing of antibiotics has played a role in a growing rate of antibiotic resistance, where bacteria evolve to the point that traditional drug treatments are no longer effective.
Antibiotics also aren't without their side effects either. These can include vomiting, nausea and diarrhea, which, when not really needed, can be worse than whatever condition the drug was supposed to treat, Dr. Stenehjem noted.
This can be true for any patient who takes antibiotics, not just patients who are more vulnerable. Currently, in the U.S, one patient dies every 15 minutes because of the effects of antibiotic resistance.
Some reminders about antibiotics:
- Most respiratory conditions are caused by viruses and antibiotics don't cure viruses
- Antibiotics may do more harm than good, with side effects such as nausea, diarrhea, rash, and yeast infections.
- Antibiotics can cause a severe form of diarrhea called Clostridioides difficile (C. diff), which can be life-threatening.
- Antibiotics become less effective when used inappropriately.
"Antibiotics are not benign. They're intended to provide benefits to patients, but they can have unintended consequences," Dr. Stenehjem added. "If we can lower over-prescription rates, we can slow antibiotic resistance and prevent patients from experiencing these sometime painful side effects when the drug won't even work on what's causing them harm."
Patients will also play a critical role in this initiative. Visitors will see signage in Intermountain urgent care facilities reminding them that antibiotics are only needed for treating bacteria-based infections.
Patients should also be prepared to receive instructions from physicians for what's called, "watchful waiting," the practice of keeping an eye on symptoms to see if they improve with time.
In addition to watchful waiting, some patients who have a sinus or ear infection may get a delayed prescription from their doctor for an antibiotic that can be filled at a later date, if their
symptoms don't improve.
Intermountain has also developed fact sheets and therapy check lists for treating cold, flu and other symptoms.
You can find them, along with other resources resources related to this initiative at: www.intermountainhealthcare.org/antibiotics
Intermountain Healthcare is a not-for-profit system of 24 hospitals, 215 clinics, a Medical Group with 2,500 employed physicians and advanced practice clinicians, a health insurance company called SelectHealth, and other health services in Idaho, Utah, and Nevada. Intermountain is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes and sustainable costs. For more information, see intermountainhealthcare.org.
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