Saturday, July 19, 2014

Evaluating retail based clinics

I think the rise of "minute clinics" and other convenient care centers in retail areas is a good idea, providing access to people in convenient settings.  But it is appropriate to review the actual clinical performance of such centers to make sure they add value to the healthcare system and patients and don't simply grab their share of the 19% of GDP.

Here's a thoughtful commentary on the topic by Budd Shenkin, as he reviews a recent study on the matter.  Here's a teaser:

Retail Based Clinics (RBCs) are one of the most recent American organizational innovations. Ready access to acute care, especially during evenings and weekends, has long been neglected by our health care system. Large pharmacy companies have taken advantage of their access to capital and their high visibility in communities to establish RBCs on their premises to fill that access gap. While they appear to have become financially successful, serious questions surround RBCs. Do they further fragment an already fragmented system? Do they provide high-quality care? Do they succumb to the temptation to drive further profits by prescribing too many medicines to be bought at the parent company's store where they are located?


Barry Carol said...

From a healthcare system perspective, the biggest potential value of these clinics, I think, is to reduce the number of ER visits for issues that can be handled in a much less expensive setting. For patients that can’t get a same day appointment with their primary care doctor if they have one, the clinics or an urgent care center can provide the peace of mind that comes from having your issue addressed on a timely basis without going to the ER.

Even if care provided by the clinics is not always optimal such as inappropriately prescribing antibiotics, as long the patient isn’t harmed, we are probably net better off from a systemwide cost standpoint. It’s also worth noting that since these clinics are largely staffed by NP’s, patient expectations are probably not as high as they would be when seeing a doctor.

I think people could benefit from making more use of nurse hotlines offered by most large health insurers. I’ve used this resource twice including once while on vacation over 2,000 miles from home and a visit to the ER was prevented both times.

Nancy Thomas said...

We, in Rhode Island, are awaiting this "lively experiment"! Given that the staff at Minute Clinics are to be NPs, for the most part, is this not exactly who you see at your GP office these days? Your primary care doc is likely to be an annual touchbase, while care is, for the most part, in the capable hands of a NP or in the case of my doctor's office, an osteopath. As our doctors' offices have sought to make us comfortable in seeing these ancillary medical experts, they cannot now say that they aren't good enough in the clinic setting. With records being sent to one's primary care group, or referrals made to one within 5 miles who has agreed to take new patients (good luck finding that in RI), most worries are needless, if one follows the current logic. I am certain that CVS does not need even ONE mishandling, so we await this natural extension of a broken medical system...perhaps instead of telling us all that will be wrong with it, health leaders should seek to embrace it, as patients will, and strengthen it. By that would make too much sense to expect, I suppose.