The increasing spread of the urgent care setting has become a blessing and a curse. While this instant care has helped to provide emergent care for non-life-threatening issues, urgent care is also now regarded by patients as a primary care setting where infectious diseases are treated. In a recent assessment of the antibiotic prescribing rate, 46% of inappropriate prescribing of antibiotics were generated from the urgent care setting. From a healthcare provider's perspective, one cannot help to assume that such a prescribing pattern would lead to an increased risk of antibiotic-resistant infections and incidence of Clostridium difficile in the community. Unfortunately, this places a high economic and disease burden on the patient and society.
With an increasing rate of inappropriate antibiotic prescribing, how is it possible to achieve the goal of the U.S. National Action Plan for Combating Antibiotic-Resistant Bacteria, which is to reduce the inappropriate use of antibiotics by 50% by the year 2020? Inappropriate antibiotic use increases the risk of resistance, increases the risk for harmful side effects, and also poses a threat not only to the individual, but to the public health community.
To decrease these risks, there would have to be an impactful intervention and plan to ensure the safety of our patients. Such an undertaking would require a joint commitment from not only the urgent care setting, but all health care providers. Even patients themselves would need to become more responsible when it comes to the use of antibiotics. However, the definition of "responsible use of antibiotics" to some providers means being very conservative with antibiotic prescribing, causing patients to be either frustrated with the care they received at the center or the patient being admitted to the hospital as a consequence of suboptimal care.
There is a bridge to all these stakeholders: The Pharmacists. A Doctor of Pharmacy.
The clinical pharmacist has the training that has prepared them to be an integral member of the health care team in the urgent care setting. This training encompasses not only pharmacological knowledge, but patient-centered clinical health and wellness. In both the hospital and emergency room settings where the pharmacist has already been integrated as part of the health care team, the quality of antibiotic prescribing is improved. Additionally, there have been reports of improved patient outcomes and increased cost savings for both the health care system and patients. But despite these positive outcomes from other healthcare settings, pharmacists are rarely integrated into urgent care.
Sometimes the reason for not integrating a pharmacist into the urgent care setting is because of the lack of understanding of what a pharmacist is trained to do. But pharmacists can help improve the quality of antibiotic prescribing in the urgent care setting because:
- They understand how a patient's medications interact with each other
- They have a deeper understanding of how drugs can negatively impact a patient if they have a certain disease or allergy
- They are trained to understand how drugs can negatively impact a patient if the patient eats a certain food or takes other dietary supplements
- They know how certain patient behaviors or attitudes influence the effectiveness of medications.
Most importantly, pharmacists are trained to understand the diagnosis made and if a drug prescribed is appropriate for a patient's care plan. Pharmacists can advise health care providers in urgent care settings about the safe and appropriate antibiotic selection.
The integration of a clinical pharmacist as a healthcare team member in urgent care settings can not only combat inappropriate exposure to antibiotics, and in the long-term, reduce the risk of antibiotic resistance and incidence of C. difficile, but also improve quality of antibiotics prescribed, improve patient outcomes, and increase cost savings.
Arinze Nkemdirim Okere, PharmD, MBA, BCPS, BCCP, is an associate professor of pharmacy, and Onyeka Ibe is a PharmD candidate at Florida A&M University in Tallahassee.