Introduction
Urgent care clinics have rapidly become a major point of access for acute conditions in the United States, particularly for infectious diseases. 1,Reference Black and Adjaye-Gbewonyo2 Respiratory infections such as influenza-like illnesses, the common cold, and streptococcal pharyngitis are among the most frequent reasons for urgent care visits. 3 Otitis media (ear infections) and urinary tract infections (UTIs) are also common for urgent care clinics among children and women, respectively. 3 While non-urgent clinics also treat infectious diseases, patients are often older and managed for chronic conditions. Reference Santo and K.4
Understanding how antimicrobial prescribing differs across settings is essential for tailoring antimicrobial stewardship strategies. Previous studies describe differences in patient demographics, visit timing, and access patterns, but there has been limited examination of antibiotic prescribing trends in urgent versus non-urgent care facilities. Reference Honigman, Wiler, Rooks and Ginde5 This study aims to evaluate demographic trends, infection diagnoses, and antibiotic prescribing patterns across urgent and non-urgent settings within a single healthcare system to identify key areas for antimicrobial stewardship intervention.
Methods
A retrospective, cross-sectional study was conducted using data from a single health system from January 2021 to December 2024. Data were obtained from the Collaboration to Harmonize Antimicrobial Registry Measures (CHARM) database. The CHARM database extracts antibiotic prescribing data and related information from the electronic medical records (EMRs) of participating outpatient facilities. CHARM supports antimicrobial stewardship by providing participating facilities with timely, standardized dashboards to monitor antibiotic prescribing patterns. Reference Sohn, Pontefract, Dahal and Klepser6 Specific extracted variables included patient age (0–5, 6–17, 18–60, and 60+ years), sex, race, insurance type, day of visit, diagnosis category based on the ICD-10 codes, and prescribed oral antimicrobial. The primary objective was to describe the frequency of infectious disease encounters and antibiotic prescriptions by setting. Comparisons of diagnoses and prescriptions were further stratified by age group to highlight differences.
Descriptive statistics included counts, frequencies, medians, and interquartile ranges (IQR). Group comparisons were conducted using χ2 or Fisher’s exact tests (n < 5) for categorical variables and Mann-Whitney tests for continuous variables. Analyses were performed in R (R Core Team, 2025) and Microsoft Excel (2021, Professional Plus) with significance defined as α < .05. This study received a waiver of consent as it was deemed not human subjects research by the Ferris State University Institutional Review Board.
Results
Ninety-three facilities were included: 7 urgent care and 86 non-urgent care clinics. There were 161,328 outpatient encounters representing 85,137 patients. Of these, 14.1% occurred in urgent care and 85.9% in non-urgent care. In total, 180,332 antimicrobial prescriptions were issued. See Figure 1 for comparison between settings; more detailed data, including age group stratification, are provided in the Supplemental Appendix. Urgent care patients were younger (median 45 vs 55 yr, p < .001), with a greater share of children aged 0–5 (9.0% vs 5.3%, p < .001) and 6–17 years (12.7% vs 7.7%, p < .001). Patients aged 60 + years accounted for 43.8% of non-urgent encounters compared with 34.1% in urgent care (p < .001). No difference was seen in sex distribution between settings; females comprising approximately 63% of all encounters (p = .15). Although most visits involved White patients overall, the proportion was lower in urgent care (89.2% vs 92.7%, p < .001).
Figure 1. Comparison of urgent and non-urgent encounters, CHARM 2021 – 2024 Bar charts showing differences in patient demographics, diagnosis, and prescription between urgent and non-urgent care settings. Demographic variables include age groups, sex, race, insurance type, and day of visit. Each bar represents the percentage of total encounters within each category. Abbreviations: CHARM, collaboration to harmonize antimicrobial registry measures; UTI, urinary tract infection; SSTI, skin and soft tissue infection; amox/clav, amoxicillin/clavulanate.
Urgent care encounters were more likely to be associated with private insurance (49.9% vs 36.9%, p < .001), Medicaid (13.1% vs 10.7%, p < .001), or self-pay (3.6% vs 2.4%, p < .001); non-urgent care was more likely associated with Medicare (29.8% vs 28.1%, p < .001). Weekend visits were substantially higher in urgent care (19.5% vs 8.6%, p < .001).
Infectious disease encounters accounted for most of visits in both care settings. Upper respiratory tract infections (URTIs) such as acute pharyngitis and otitis media were more frequent in urgent care (15.0% vs 6.7%, p < .001; 11.9% vs 7.6%, p < .001, respectively). COVID-19 was also more common in urgent care (6.3% vs 1.6%, p < .001). UTIs were more common in non-urgent care (15.2% vs 13.8%, p < .001). Regarding antibiotic prescribing, amoxicillin was most frequently prescribed in urgent care (17.4%), followed by doxycycline (15.0%) and amoxicillin/clavulanate (12.0%). In non-urgent care, cephalexin led (13.5%), followed by doxycycline (12.6%) and amoxicillin (11.4%).
Discussion
Our study highlights differences between infectious diseases encounters in urgent and non-urgent outpatient care. Urgent care encounters more often involved younger patients, especially children, and were associated with acute respiratory infections. In contrast, non-urgent care served a larger proportion of older adults and was more frequently associated with UTIs. These differences reflect not only patient demographics but also visit timing, as urgent care absorbs more after-hours and weekend demand. Reference Allen, Cummings and Hockenberry7 Antibiotic prescribing mirrored these patterns: amoxicillin was more commonly prescribed in urgent care, reflecting its first-line role for pediatric URTIs, whereas cephalexin was more common in non-urgent care, consistent with higher rates of UTIs and skin infections in older populations. Reference Nelson, Aslan and Beahm8–Reference Pellegrino, Timitilli and Verga10
This study has several limitations. First, antibiotic appropriateness was not directly linked to specific diagnoses. Additionally, the population consisted of predominantly White patients, limiting generalizability to more diverse regions. Finally, missing or non-specific ICD-10 codes may have led to misclassification of infectious disease encounters. Despite these limitations, the large sample and standardized data provide valuable insights into setting-specific prescribing patterns. Future work addressing these limitations would substantially strengthen these findings by enabling evaluation of concordance with guideline recommendations.
Overall, these findings reinforce the importance of tailoring antimicrobial stewardship interventions by care setting and patient age. Stewardship strategies in urgent care should emphasize judicious prescribing for respiratory conditions, while efforts in non-urgent care may prioritize older adults and urinary or skin infections. Understanding these differences is essential for improving antibiotic use across the continuum of care. Reference Brown, Ackerman and Ruttan11
Supplementary material
To view supplementary material for this article, please visit https://doi.org/10.1017/ash.2025.10197.
Financial support
This study was conducted as part of a quality improvement initiative under the CHARM project at Ferris State University College of Pharmacy, with funding support from the Michigan Department of Health and Human Services (MDHHS). No additional external financial support was received.
Competing interests
All authors report no conflicts of interest relevant to this article.
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