How Good is Health Care Delivered in Retail Stores?

 

Dear Readers,

Your introduction to “shopping mall” medicine might have been at the supermarket, where a nurse was offering flu shots next to the cantaloupes. Or you got your blood pressure checked at the drugstore in a nook next to the pharmacy. Maybe you had your sore throat examined after work at a CVS “MinuteClinic.”

More and more Americans are using walk-in clinics for problems as varied as sore throats, ear infections and urinary tract infections. These clinics sell convenience, but quality too, we hope.  So this month’s issue examines the growing trend of retail medicine and how you can get the best and safest care in these settings.

 

Why We Need Retail Clinics

Retail clinics offer a wide array of medical care, but most people rely on them for services of limited scope where there are clear-cut published treatment guidelines. Generally these clinics are staffed by nurses, nurse practitioners and physicians assistants. Many are an excellent option for primary care not only for their familiarity with common, relatively minor problems, but because they often feature extended and weekend hours, and can refer patients to a primary care physician if they do not have one.

We need retail clinics because primary care doctors’ offices are often so hard to get into for something we think needs treatment soon, but doesn’t count as a true emergency.  Also, too often, primary care is out of reach of people who aren’t insured. Often, those folks neglect health problems, then turn to the emergency room for something that might have been treated more appropriately at the doctor’s office.

 Plus, there’s a shortage of primary care doctors. In an editorial published last month in the Journal of the American Medical Association (JAMA), Dr. Christine K. Cassel said that first-line roles for advanced practice nurses and pharmacists are effective in managing acute, uncomplicated conditions. At a retail clinic, the patient can be seen quickly, often with a straightforward evaluation and treatment or a recommendation to seek specialized care if appropriate.

The Cost Advantage of Knowing the Price Up Front

Everyone — employers, insurers, government agencies and especially consumers/patients — is concerned about the cost of medical care. According to Kaiser Health News, retail clinic costs are as much as 30 percent to 40 percent less than similar care at a doctor’s office, and 80 percent less expensive than at an emergency room.

If you have insurance, the cost of a retail clinic visit for something as common as fever and a sore throat would be a small deductible or co-payment; often as little as $10-$30. Without coverage, most visits still are less than $100, and the pricing is transparent. That means costs are set for given treatment, and you know in advance what you’ll pay.  Surveys have found the pricing is one of the most popular features of retail clinics.

Coordinating Care: The Key Quality Issue  

Sniffles and flu shots are one thing, but anyone with more advanced and ongoing care needs has to be careful about not creating fragmentation in your care by multiple stops at various walk-in clinics where one clinic has no clue about the other’s care for you.

All your caregivers should have complete records of history, diagnoses, tests, medications and other treatments, and retail clinics are no exception.

Multiple and chronic problems require more careful attention to the individual; they require a personalized treatment plan commonly called coordinated care or disease management. See our blog post “Lack of Coordinated Care Costs Time, Money and Sometimes a Good Outcome” to learn more. Disjointed care not only can cause harm, invariably it’s more expensive.

Because retail clinics generally are located within drugstores, they are well-suited to coordinate care particularly for prescriptions. Proximity to a pharmacist and the pharmacy database make tracking all your meds easier and consultation with the pharmacist more useful.

Even patients with chronic problems can receive excellent care in a retail setting.  Many such facilities, for example, have established programs to help diabetics monitor and control their condition, and pharmacist counseling is part of the package.

Generally, if patients with chronic illnesses who otherwise don’t-or won’t-seek medical attention do patronize retail clinics, they’re more likely to take their medications and practice other habits that prevent them from getting worse. As one medical professional interviewed by KHN asked, “If you have a stable diabetic, why should that person be going in to see a physician when a nurse practitioner can manage care of that patient?”

Making the Most of Retail Health Care

Retail medicine is an evolving universe: State laws vary in their oversight of medical centers and some prohibit clinics from employing doctors, nurse practitioners or physician assistants directly. Some state limit the number of nurses a doctor can oversee. Some medical associations want to prevent nurses from practicing autonomously.

If you opt for retail care, you must ensure that it is professional and appropriate. As noted above, you need to take steps to prevent your care from becoming dangerously fragmented. A few more tips for the best, safest care:

  • If you’re considering a retail clinic, ask about the credentials of its staff-at least one person on duty should be a nurse practitioner or physician assistant-and under what circumstances are physicians consulted.
  • If you have a chronic or complicated medical issue, see a physician first. Once a diagnosis and treatment plan are in place, you might be able to transfer your ongoing care to a retail clinic with equivalent or superior results.
  • Get copies of all your clinic records. Keep one for yourself, and provide your primary care and specialist doctors with a copy. Remember: Retail care is as much a part of your medical history and ongoing care as any care provided in a doctor’s office, urgent care facility or hospital. See our blog post, “Do All Your Caregivers Have Your Test Results?

Retail care requires you to become your own “case manager.” If you do that job well, many medical professionals, include Christine Cassel, are optimistic about the outcomes. “[W]ith … convenient access in evenings and on weekends,” she writes in JAMA, “and familiarity with local community resources, the retail clinic potentially could be an important component of coordination of care aimed at reducing disease exacerbations, unnecessary hospitalizations and adverse drug interactions. If this vision were realized, the retail clinic phenomenon could be transformative for a vast number of patients in the United States.”

 

To your continued health!

Sincerely,
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Patrick Malone
Patrick Malone & Associates