Retail health clinics fill demand for rapid care

Staff Writer

 Walk-in health care clinics at pharmacies are booming as customers demand quick service.  METRO CREATIVE SERVICES Walk-in health care clinics at pharmacies are booming as customers demand quick service. METRO CREATIVE SERVICES Quick and convenient are two words typically associated with fast foods or ATMs, not health care services. A growing trend is changing that as retail-based clinics (RBC) are popping up in drugstores and supermarkets across the country.

“Retail clinics provide access to affordable, convenient and high-quality health care,” said Tine Hansen-Turton, executive director, Convenient Care Association, the national trade association of companies and healthcare systems that provide consumers with retail-based locations. Among families using retail clinics for the first time, Hansen- Turton said, the major reasons for visiting them were convenient hours, location and not needing to make an appointment. Thirty percent of the population lives within 10 minutes of a convenient care clinic, she said.

That number is growing as retail clinics are expected to increase at an estimated annual rate of 25 to 30 percent, Hansen-Turton said.

“By 2017, the number of projected convenient care clinics is 2,800, according to recent studies,” she said. Drug stores, such as CVS Pharmacy, operate convenient care clinics across the country. According to the CVS corporate medical call center representative, Stephanie Johnson, there are approximately 1,100 MinuteClinics offering quick care for a variety of ailments.

The recent experience of a Jackson mom highlighted the convenience of retail-based clinics. Certain that her son had an ear infection, she called his pediatrician. “The receptionist told me the pediatrician was at a conference, and she referred me to another pediatrician in Howell. I tried calling their office over and over again; I was getting a message that said the office is open from 9 a.m. to 5 p.m., and I was calling between 9-9:30 a.m., but couldn’t get a live person on the phone,” the Jackson mom said.

When she finally did get a call back, a receptionist told her that appointments were not available until late in the day, and suggested a CVS MinuteClinic.

The Jackson mom took her advice and and went to the nearest MinuteClinic. Within 10 minutes of arrival at the clinic, her son was being examined by a medical professional.

“She (the nurse practitioner) weighed him, took his blood pressure and pulse, listened to his heart, and looked at his eyes, throat and ears, and diagnosed his ear infection in a matter of a couple minutes. She prescribed an antibiotic, which we were able to pick up right there at the CVS pharmacy. My son was with the sitter and resting by 11:30, and I was at work by noon,” the Jackson mom said.

“The most common issues are sinus, strep throat, flu, pink eye, bug bites and minor cuts. We see patients 18 months and older and take insurance,” Johnson said.

The clinics, staffed with either a nurse practitioner or physician’s assistant, do not offer physicals or TB testing, Johnson said.

Research has shown, Hansen-Turton said, that the cost of services is lower at convenient care centers than at other healthcare providers, such as urgent care facilities, emergency rooms and primary care offices.

“Traditional healthcare providers initially felt threatened by a disruptive newcomer to the medical field, but today nearly all the major retail clinic operators have affiliations and partnerships with over 100 hospitals or major medical groups,” Hansen-Turton said.

Many of those in the medical community see retail clinics as a partner, according to Hansen-Turton. Yet, others in the medical community have reacted to consumer use of RBCs with a caveat.

The American College of Physicians (ACP) said retail clinics are “best used as a backup alternative to a patient’s primary care physician for the diagnosis and treatment of episodic minor illnesses.”

Retail clinics, according to the ACP, provide a limited scope of primary care services for adults and children with a nurse practitioner or physician assistant with no physician on site.

“The use of retail health clinics is generally not appropriate for patients with multiple and/or chronic health conditions such as heart failure, respiratory diseases, HIV, kidney problems, etc. The best quality care for those conditions are best provided by a primary care general internist, a family physician, and/or a specialist trained in the care of such complex patients. Thus, such clinics are best for generally healthier patients with minor ailments,” said Dr. Wayne J. Riley, president of the American College of Physicians.

The ACP offers guidelines for use of retail clinics, which include that all patients should establish a longitudinal care relationship with a physician; retail health clinics should have a well-defined and limited scope of clinical services that are consistent with state scope-of-practice laws and with the more limited physical space and infrastructure that such a setting permits; retail clinics should use standardized medical protocols based on evidence-based practice guidelines; retail health clinics should have a structured referral system to primary care settings and encourage patients they see to establish a longitudinal relationship with a primary care physician if the patient does not have such an existing relationship; and it is primarily the responsibility of the retail health clinic to promptly communicate information about a retail health clinic visit to a patient’s primary care physician.

“Retail clinics may be appropriate for the treatment of minor, acute illnesses, but they can’t replace a personal physician who is familiar with a patient’s medical and family history, coordinates care over a spectrum of conditions with other health care professionals, and can perform much more sophisticated testing and diagnosis and treatment techniques when appropriate,” said Dr. Robert Wergin, a Nebraska family physician who is board chairman of the American Academy of Family Physicians (AAFP).

The AAFP states that RBCs are not the only source of convenient care available for patients today. The overwhelming majority of family physicians offer same-day scheduling in their practice and roughly half of all family physicians have extended office hours for patients to seek care, according to the AAFP.

The American Academy of Pediatrics (AAP) issued a statement which “opposes retail based clinics as an appropriate source of medical care for infants, children and adolescents, and strongly discourages their use.”

“The risk is for the increased likelihood of fragmented child care,” said Fran Gallagher, executive director of the AAP’s New Jersey Chapter.

RBCs, Gallagher said, “unintentionally fuel fragmented care and increase the risk of missing a diagnosis.”

“We as pediatricians believe that all children in the United States deserve quality care and a medical home,” said Dr. Alan Weller, vice president elect for the New Jersey chapter of the AAP and associate director, division of general pediatrics at Rutgers Robert Wood Johnson Medical School, New Brunswick.

According to the AAP, a medical home is a family-centered partnership within a community based system that provides uninterrupted care with appropriate payment to support and sustain optimal health outcomes.

The medical home, Weller said, is made up of a team of health care providers that includes doctors, nurse practitioners and physician’s assistants.

The medical home offers “opportunities to encounter a family, answer questions and have conversations,” Weller said.

Additionally, Weller said, medical homes have made access easier and more convenient with extended hours in the evenings and on weekends.

The AAP outlined issues of concern with retail clinics: disrupting the continuity of care — providers at these clinics make diagnoses based on incomplete information; lack of pediatric trained medical providers — pediatricians and physicians are not on site to provide support; lack of regulation — retail clinics are not reviewed for compliance in the way that pediatric offices are reviewed; and public health concerns — a clinic within a retail setting could increase exposure to communicable diseases such as chickenpox, pinkeye and others.

Retail-based clinics fill a need for convenience, but cause the “loss of a comprehensive continuum of care by primary care providers,” Gallagher said.

When a child “gets a physical here and a flu shot there, nobody is looking at the big picture,” said Michael Weinstein, communications director, New Jersey Chapter, AAP.

“There has to be a central location to look at the entire picture for the family, look at all pieces of the puzzle, look at gaps and duplications in care,” Weinstein said.

In addition, Gallagher said, RBCs miss the opportunity to screen for anxiety and depression in children.

“Right out the gate, there is a big difference in training. It is not the same standard or quality of care,” Gallagher said.

Nurse practitioners, who generally staff RBCs, have approximately 500 to 720 hours of clinical training, whereas pediatricians undergo between 12,000 and 14,000 clinical hours of training, according to Weinstein.

This disparity, Gallagher said, provides pediatricians with a “far broader range of competencies for assessing and managing health issues in children.”