title: Antibiotic prescribing for respiratory infections at retail clinics, physician practices, and emergency departments.
abstract: OBJECTIVE
  To compare antibiotic prescribing among retail clinics, primary care practices, and emergency departments (EDs) for acute respiratory infections (ARIs): antibiotics-may-be-appropriate ARIs (eg, sinusitis) and antibiotics-never-appropriate ARIs (eg, acute bronchitis).
  
  
  METHODS
  We analyzed retail clinic data from the electronic health records of the 3 largest retail clinic chains in the United States, and data on visits to primary care practices and EDs from the nationally representative National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.
  
  
  METHODS
  Using multivariate models, we estimated an adjusted antibiotic prescribing rate for each site of care, controlling for differences in patient characteristics and diagnosis.
  
  
  RESULTS
  From 2007 to 2009 in the United States, there were 3 million, 167 million, and 29 million ARI visits at retail clinics, primary care practices, and EDs, respectively. For all ARI visits, the adjusted antibiotic prescribing rate at retail clinics (58%) was similar to the rate at primary care practices (62%; P=.09) and EDs (59%; P=.48). For antibiotics-may-be-appropriate ARI visits, the adjusted antibiotic prescribing rate (95%) at retail clinics was higher than at primary care practices (85%; P<.01) and EDs (83%; P<.01). For antibiotics-never-appropriate ARI visits, the adjusted antibiotic prescribing rate (34%) at retail clinics was lower than at primary care practices (51%; P<.01) and EDs (48%; P<.01).
  
  
  CONCLUSIONS
  Compared with primary care practices and EDs, there was no difference at retail clinics in overall ARI antibiotic prescribing. At retail clinics, antibiotic prescribing was more diagnosis-appropriate.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115. E-mail: Mehrotra@hcp.med.harvard.edu.
authors.forename: Ateev
authors.initials: A
authors.lastname: Mehrotra
authors.forename: Courtney A
authors.initials: CA
authors.lastname: Gidengil
authors.forename: Claude M
authors.initials: CM
authors.lastname: Setodji
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Burns
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents