Prepared Patient: Retail Clinics - Health Care On Aisle One

Main Category: Public Health
Article Date: 21 Aug 2008 - 3:00 PDT

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You've got that telltale tickle in your throat again, and you're pretty sure it's not just another cold. But your doctor's office says the next open appointment is in two weeks. You're traveling for business in another city. You don't have a primary care physician to call. You're self-employed and don't have health insurance.

For all these reasons and more, potential patients are turning increasingly to retail clinics to cure their minor ailments.

According to a 2008 report by Mary Kate Scott of Scott & Co., the number of retail clinics in the United States grew from 150 to nearly 700 clinics last year. Renting space in drugstore chains such as CVS and Walgreens, major retailers such as Wal-Mart, and even hospitals, the clinics are filling a need for convenience, cost and a more consumer-like approach to health care.

What's on the Menu…

Most retail clinics operate something like this: Appointment times are guaranteed, but up to 90 percent of patients just walk right in. They start by choosing their problem from the clinic's menu of common complaints think bronchitis, ringworm, ear infections. Many clinics also offer services such as childhood and adult vaccinations, pregnancy tests, and seasonal items such as flu shots and school and camp physicals. There are set prices for all of these services, displayed at the clinic's entrance. Patients then sign up to see a health care specialist, who could be a nurse practitioner, physician's assistant or even an M.D. in some cases. Most consultations take less than 15 minutes.

Tim, a college student in Tucson, Ariz., was miserable with another sinus infection. All the familiar signs were there, and he knew from past experience that antibiotics would be the only sure cure. But instead of calling for an appointment with his primary care doctor and pulling out his insurance card, Tim went shopping.

On his way home from campus, Tim stopped in at a retail clinic in his local drugstore. Within a few minutes, a nurse practitioner had confirmed his diagnosis with a simple exam and a thorough symptoms checklist "that was roughly as long as the one they use to launch the space shuttle," he joked. He went away a satisfied customer, antibiotics prescription in hand.

Nancy Dawson, a nurse practitioner and manager of operations for Minute Clinic in Tucson, says convenience seems to be a big factor in whom the clinics attract. Parents with young children and young adults are some of the heaviest users, "although we see all age groups," she says. "It depends on the time of year, whether it's flu season, time for seasonal allergies, or with our younger population, time for physicals."

There's no need to bring your full medical history along if you choose to use a retail clinic, but be prepared at least to tell the clinician about any current medications you're taking, including any vitamins or supplements. If you're there to get a vaccination, it's helpful to bring in your shot record so that the vaccination can be recorded.

After your treatment, you'll receive a printout of the results of your physical exam, your vital signs such as blood pressure, any in-clinic treatment you received, and any medications prescribed. The clinics can send a record of this record to your primary care physician if you ask them to do so and will also submit the records to your insurance company at your request.

Most clinics accept a patient's health insurance. And for the uninsured, some data suggest that the clinics can offer basic preventive and acute care at prices lower than those incurred in the ER or urgent care clinics. The retail clinics keep their costs down by limiting their services and their space exam rooms are about the size of a walk-in closet in most places. There's no room for an X-ray machine or ultrasound, lab, or other expensive equipment.

…And What's Not

Lacerated arm? Broken ankle? Clinical depression? Sorry, the retail clinic is not for you.

"We can't treat sprains, strains or fractures because we have no X-ray machines," says Mila Garcia, a nurse practitioner and manager of operations for the Phoenix Minute Clinics. "The other things that people ask for all the time and that we don't do are pain medications, especially for migraines."

For the most part, Dawson says people "are very well-versed" in what the clinics do and do not offer. "For those who don't know what our service includes, an electronic message board spools the information. And some people just want direction on what the next step in taking care of themselves would be."

The clinics "are great for people who are relatively healthy, but once you're taking multiple medications or have multiple chronic conditions, you should be seeing your primary care doctor," Scott recommends.

The clinics can also offer a referral to primary care doctors within a few miles' radius who are taking new patients. "If you don't have a medical home, we try to direct you toward one," Dawson said.

Health Care in Aisle One

As retail clinics become more popular with patients, they may add more preventive care and options to manage chronic conditions, such as intravenous therapy and downloading data from medical devices, Scott says.

The Phoenix clinics already work with the CVS drugstores to offer different preventive health screenings each month, including blood pressure, cholesterol, diabetes and skin cancer analysis, Garcia says.

Doctors' groups in a few states such as Tennessee and Kansas have raised questions about whether there is enough doctor supervision of these clinics, most of which are staffed by nurse practitioners. The American Academy of Family Physicians does not endorse the clinics, saying they could interfere with a patient establishing a "medical home" with a primary care doctor.

The American Medical Association has softened its stance on retail clinics, although the group recently called for a ban on the sale of tobacco or tobacco-related products in stores which house the clinics.

SIDEBAR/BOX

Retail Clinics: The Right Choice?

Not sure if a retail clinic is the right choice for you? Take a look at our list of pros and cons to find out what you could gain or lose if you decide to step inside.

(Adapted in part from, Retail Medical Clinics: Okay in a Pinch, but No Substitute for Real Health Coverage, Families USA )

PRO

Guaranteed appointment times

Short consultations most less than 15 minutes

Convenient locations and hours

Up-front pricing

Lower prices than ER or urgent care

Cash or insurance accepted

Electronic health record available at all locations

Some studies suggest clinics more likely to practice evidence-based medicine

CON

Short consultation may not leave much time to explain health history, details of current complaint May detract from the development of a "medical home" and relationship with primary care doctor Limited set of conditions treated care for chronic conditions and major ailments not available May miss important follow-up care required for certain conditions, such as infections Some insurance companies waive co-pay at clinics which could force some patients to choose clinics when they would prefer to see their primary care doctor Oversight of clinics varies from state to state Usually will not be treated by an M.D.

Health Behavior News Service
Center for the Advancement of Health, 2000 Florida Ave. NW, Ste. 210
Washington, DC 20009
United States
http://www.hbns.org