Today’s Managing Health Care Costs Number is 8.6 million
NPRcovered a BMJ opinion piecelast week that asserted that women should be able to self-prescribe antibiotics when they have urinary tract infections. Some in the medical community oppose self-prescription. They worry it will cause
- Overuse of antibiotics, with attendant resistance and yeast and other infections
- Use of the wrong antibiotics, since this will decrease the frequency of urine cultures
- Misuse of antibiotics, which could include not understanding that antibiotics generally decrease the effectiveness of the birth control pill, and have other drug-drug side effects
- Overall increase in the cost of health care.
But that’s just ridiculous. Young women know when they have urinary tract infections, and providers treating women with the pain of a urinary tract infection don’t wait for the results of the culture anyway. Antibiotics prescribed by pharmacists in a 24 hour CVS or Walgreens could be accompanied by any appropriate warning –and this certainly would not increase the cost of care compared to visits to physician offices, urgent care centers, or even emergency departments. Further, physicians very often prescribe the wrong antibiotics for UTIs, and we could restrict self-prescription to those few medications which are most safe and appropriate for self-treatment.
From NEJM in 2012:
Urinary tract infection is the most common bacterial infection encountered in the ambulatory care setting in the United States, accounting for 8.6 million visits (84% by women) in 2007. The self-reported annual incidence of urinary tract infection in women is 12%, and by the age of 32 years, half of all women report having had at least 1 urinary tract infection.
I see women in an urgent care center affiliated with a multispecialty group practice that has extended hours (through 8pm weeknights, and on both Saturdays and Sundays). Despite this excellent access, I frequently see women who have delayed getting treatment. Many of them have kidney infections, which are far more dangerous than simple bladder infections – and require longer courses of therapy.
I also was previously in a practice which offered a mobile app for women with suspected UTIs. Women answered a handful of questions; their answers were reviewed by a physician assistant or a nurse practitioner. If the diagnosis seemed correct and there were no signs of complications, their prescription was electronically transmitted to a pharmacy. Patient satisfaction was high, and if people had recurrent UTIs or worrisome answers to the questions, they were given rapid access appointments.
The treatment of UTIs is algorithmic and clearly dictated by evidence. These are low value office visits, and when we empower women to treat themselves we will lower costs, raise quality, and improve patient experience. Imagine the improved access we could offer when we eliminate many of these 8.6 million low value visits. This is a clear “triple aim” play.
