The urgent care sector in the United States has grown significantly, now comprising over 14,000 facilities and expanding at an annual rate of 7% [1]. This care setting meets the expectations of patients seeking convenient access for acute, self-limited complaints. Among these visits—estimated at 225 million annually—infectious disease (ID) complaints account for at least 15%, making diagnostic accuracy essential to timely and appropriate treatment [2].
Patients increasingly expect a definitive diagnosis and treatment plan during their visit. For this to be possible, diagnostic tools must offer both high accuracy and clinical impact, enabling providers to make evidence-based decisions during the encounter. The scope of ID presentations is broad, spanning ophthalmologic, otologic, pharyngeal, respiratory, gynecologic, gastrointestinal, dermatologic, and sexually transmitted infections. Respiratory tract infections (RTIs) account for approximately 40% of these complaints and remain a central focus due to their high volume and diagnostic complexity [3].
In many cases, experienced clinicians can make a confident diagnosis without the need for confirmatory testing. However, syndromic overlap between viral and bacterial infections, as well as between different pathogens, often undermines the reliability of clinical diagnosis alone [4]. A patient presenting with fever, congestion, and cough may have influenza, SARS-CoV-2, respiratory syncytial virus (RSV), group A Streptococcus, Mycoplasma pneumoniae, or another pathogen, each with different therapeutic implications.
When testing is unavailable or inaccurate, empirical treatment is often used, particularly with antibiotics. This strategy risks overuse, contributes to antimicrobial resistance, and may lead to inadequate treatment for viral or atypical bacterial infections [5]. The CDC estimates that at least 28% of antibiotics prescribed in outpatient settings are unnecessary, with the highest rates observed in care for respiratory conditions [6].
Rapid molecular diagnostics have emerged as a solution to this challenge, offering same-day or next-day pathogen-specific results with high sensitivity and specificity [7]. These platforms can simultaneously detect multiple respiratory pathogens, guiding more precise treatment decisions and enhancing antibiotic stewardship. For instance, identifying a viral etiology, such as RSV or rhinovirus, can prevent unnecessary antibiotic use, while detecting a treatable bacterial infection, like group A strep or M. pneumoniae, supports appropriate prescribing.
Furthermore, molecular test results can improve shared decision-making and patient adherence. When clinicians can present objective diagnostic data, patients are more likely to understand the rationale behind treatment decisions, including the choice to withhold antibiotics [8]. This is particularly important in urgent care, where patients often present expecting—or even demanding—immediate treatment.
While point-of-care (POC) antigen tests provide rapid results, their sensitivity can be limited, particularly for specific pathogens or in the early stages of infection. Available molecular POC tests can provide both sensitive and rapid detection, but continue to be available for only a subset of pathogens. For cases beyond what POC tests provide, molecular tests processed off-site remain valuable. Even a next-morning result can influence therapy, reduce return visits, and enhance confidence in clinical judgment.
The use of these advanced diagnostics does not aim to replace clinical skill but to complement it. When applied judiciously, molecular testing enhances outpatient care by clarifying otherwise uncertain diagnoses, particularly in high-volume urgent care settings where time and accuracy are of the utmost importance.
In summary, rapid molecular testing enhances the management of outpatient infectious diseases by increasing diagnostic certainty, reducing the use of inappropriate antibiotics, and supporting informed patient engagement. As the healthcare system continues to shift toward more decentralized, same-day care, these tools are poised to play an increasingly important role in delivering timely, appropriate, and cost-effective treatment.
References
1. Urgent Care Association. “2023 Benchmarking Report.”
2. National Center for Health Statistics. “National Ambulatory Medical Care Survey: 2021 Summary Tables.”
3. Ramaswamy R, et al. “Respiratory Tract Infections in Urgent Care Settings.” J Urgent Care Med. 2021.
4. Lieberthal AS, et al. “Clinical Practice Guideline: The Diagnosis and Management of Acute Otitis Media.” Pediatrics. 2013.
5. Fleming-Dutra KE, et al. “Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits.” JAMA. 2016;315(17):1864–73.
6. CDC. “Antibiotic Use in the United States, 2021 Update: Progress and Opportunities.”
7. Brendish NJ, et al. “Impact of Molecular Point-of-Care Testing for Respiratory Viruses on Antibiotic Use.” Lancet Respir Med. 2017;5(5):401–11.
8. Mangione-Smith R, et al. “Communication Practices and Antibiotic Use for Acute Respiratory Tract Infections in Children.” Ann Fam Med. 2015;13(3):221–7.
Steven Goldberg, MD, MBA
Dr. Goldberg serves as Chief Medical Officer of HealthTrackRx, the nation’s leader in outpatient infectious disease diagnosis. He is a family medicine physician and practices urgent care and family medicine at UofLHealth in Louisville, KY.
