Retail Clinics Branch into Chronic Disease Treatment

Pretty soon, retail clinics won't be just for strep throats any more -- they'll also be for managing diabetes and other chronic diseases.

"It's a new service strategy," Sandra Ryan, chief nurse practitioner officer for TakeCare Health Systems, said at a meeting on retail clinics sponsored by the Convenient Care Association and the Jefferson School of Population Health. TakeCare operates retail clinics inside Walgreen pharmacies.

"We're evolving our clinic offerings from episodic treatment to looking at how do we get more chronic disease management, how do we do more prevention, how do we do more screening?" she said.

Becoming Part of the Team

The meeting featured speakers from several of the retail clinics, most of which are located inside pharmacies or grocery stores, although a few are freestanding. Up until now, they've generally treated acute illnesses such as colds, strep throat, and urinary tract infections; some have also provided vaccinations and sports physicals.

But that's going to be changing, according to Ryan.

"We have recently done some research that showed that people are willing to come be treated for high blood pressure, asthma, and high cholesterol" at retail clinics, she noted. "Knowing there's an unmet need for treatment and management of chronic conditions in the United States, and knowing that the cost is increasing, we think retail clinics are on the forefront to look into going into more chronic diseases."

TakeCare has already begun its first steps in that direction in a few clinics, which are offering spirometry testing for asthma patients and HbA1c tests to screen for diabetes. The chain also is taking on hypertension screening and diagnosis. Once patients are diagnosed with hypertension, "we are currently referring them out" for care, but the company is looking at becoming part of the hypertension management team, Ryan said.

Donna Haugland, chief nursing officer at Minute Clinic, which operates retail clinics inside CVS pharmacies, noted that about 11 percent of Americans have now visited a retail clinic at least once. She added that the cost of managing diseases such as diabetes, which affects 23 million people nationwide, "far surpasses acute illnesses."

"With fewer and fewer physicians going into primary care, we need more access sites to help control the chronic disease problem we're running into," Haugland said. We in the retail [clinic business] think we're perfectly positioned to help in the effort to chronic disease."

Thinking Outside the Box

Ryan said chronic disease visits would work differently than the short acute-care visits that make up the majority of retail clinics' business now.

"Our model is built around 20-minute visits, so some of the restructuring [might involved] more scheduled appointments," she said. Since retail clinics have peaks and lows in traffic, with busier times in the morning and afternoon, chronic disease visits -- which might be 30 minutes -- would need to be scheduled at less busy times.

Haugland said adding chronic disease management will require retail clinics to "think outside the box.

"Do we expand and put a diabetes educator in another space? Do we have some scheduled appointments and some walk-in?" she said.

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