Abstract
BackgroundProviders of on-demand care, such as those in urgent care centers, may prescribe antibiotics unnecessarily because they fear receiving negative reviews on web-based platforms from unsatisfied patients—the so-called Yelp effect. This effect is hypothesized to be a significant driver of inappropriate antibiotic prescribing, which exacerbates antibiotic resistance.ObjectiveIn this study, we aimed to determine the frequency with which patients left negative reviews on web-based platforms after they expected to receive antibiotics in an urgent care setting but did not.MethodsWe obtained a list of 8662 urgent care facilities from the Yelp application programming interface. By using this list, we automatically collected 481,825 web-based reviews from Google Maps between January 21 and February 10, 2019. We used machine learning algorithms to summarize the contents of these reviews. Additionally, 200 randomly sampled reviews were analyzed by 4 annotators to verify the types of messages present and whether they were consistent with the Yelp effect.ResultsWe collected 481,825 reviews, of which 1696 (95% CI 1240-2152) exhibited the Yelp effect. Negative reviews primarily identified operations issues regarding wait times, rude staff, billing, and communication.ConclusionsUrgent care patients rarely express expectations for antibiotics in negative web-based reviews. Thus, our findings do not support an association between a lack of antibiotic prescriptions and negative web-based reviews. Rather, patients’ dissatisfaction with urgent care was most strongly linked to operations issues that were not related to the clinical management plan.
Highlights
The World Health Organization has deemed antibiotic resistance, which is primarily caused by antibiotic overuse, to be one of the world's most pressing health problems [1]
Care providers have admitted to prescribing antibiotics—even when antibiotics are unnecessary—when they assume that patients will be unsatisfied without an antibiotic prescription [3,4]
Of a total of 200 reviews, we found that only 5 reviews (2.5%; 95% CI 0.3%-4.7%) exhibited the Yelp effect as the primary message category
Summary
The World Health Organization has deemed antibiotic resistance, which is primarily caused by antibiotic overuse, to be one of the world's most pressing health problems [1]. Providers of on-demand care, such as those in urgent care centers, may prescribe antibiotics unnecessarily because they fear receiving negative reviews on web-based platforms from unsatisfied patients—the so-called Yelp effect. This effect is hypothesized to be a significant driver of inappropriate antibiotic prescribing, which exacerbates antibiotic resistance. Objective: In this study, we aimed to determine the frequency with which patients left negative reviews on web-based platforms after they expected to receive antibiotics in an urgent care setting but did not. Methods: We obtained a list of 8662 urgent care facilities from the Yelp application programming interface By using this list, we automatically collected 481,825 web-based reviews from Google Maps between January 21 and February 10, 2019. Patients’ dissatisfaction with urgent care was most strongly linked to operations issues that were not related to the clinical management plan
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