Why are some clinics overprescribing? Because it’s profitable.

Most doctors know by now that treating a viral infection with antibiotics isn’t an effective treatment. In fact, antibiotic overprescription causes harm by contributing to antibiotic resistance. But antibiotic prescriptions for colds and other viral respiratory infections are still quite common; at least half of antibiotics prescribed are estimated to be unnecessary. 

Knowing which settings antibiotics are most overprescribed is a first step to curbing this overuse. In a recent study in JAMA Internal Medicine, researchers compared rates of antibiotic prescription for viral respiratory infections in urgent care centers, retail clinics, EDs, and medical offices. They found that 16% of visits to urgent care clinics were for respiratory infections that didn’t require antibiotics, and that doctors prescribed antibiotics for these conditions 45% of the time. This was a much higher rate than antibiotic overprescription in medical offices or EDs. 

Why are clinicians at urgent care clinics prescribing antibiotics for conditions which they are likely to cause more harm than good? In an accompanying piece, JAMA Internal Medicine editors Dr. Michael InczeDr. Rita Redberg, and Dr. Mitchell Katz give some theories behind this disparity in overprescribing.

Urgent care clinics are more easily accessible than a traditional doctor’s office and much cheaper than going to the emergency room, filling an important need in health care delivery in many communities. However, the authors speculate that lowering the barrier to access may encourage people to go to urgent care for a mild condition that would go away on its own with rest. 

Just because a patient comes into the urgent care clinic with a cold does not mean they should leave with a prescription for antibiotics. However, as the authors point out, there are more incentives for doctors at urgent care clinics to give patients antibiotics even when they don’t need them. “Patients may seek care in one of these clinics specifically because they desire antibiotics, and clinicians may worry that patients will not return to urgent care in the future if their expectations are not met,” they write. Also, because the doctor does not know the patient well, it may be harder for them to convince the patient that antibiotics aren’t necessary. 

More importantly, encouraging patients not to go to urgent care clinics for viral respiratory infections goes directly against the business model of urgent care clinics. More patients means more money. Telling patients to rest at home or use a telephone-based triage line to get their symptoms evaluated is a good way to reduce overprescription but bad for urgent care clinics’ bottom line. 

When a health care provider’s business model thrives on overprescription, how do we stop it? Education is a good place to start. Many people might be aware that antibiotics won’t help, but think that it “couldn’t hurt,” so if a doctor is offering, they might as well take it. Informing patients not only that antibiotics are unnecessary for viral respiratory infections, but that they could be directly harmed, could change people’s minds.