Retail Clinics Branch into Chronic Disease Treatment

She added that because the retail clinic business is somewhat seasonal, with the heaviest times during the winter and spring, "we need to find a way to build summer seasonality so the business can stay healthy." That's where chronic disease management could come in.

Retail clinics have grown in number since they first came on the scene in the mid-2000s. There are now 1,200 retail clinics operating in 32 states, according to the Convenient Care Association, a retail clinic trade association which was founded in 2006.

For Health Costs, Transparency is Key

To learn more about who was visiting retail clinics and why, Dr. Ateev Mehrotra of the University of Pittsburgh School of Medicine and colleagues studied national surveys of visits to retail clinics, primary care physicians, and emergency departments. They found that retail clinics appear to be serving a patient group that is underserved by primary care physicians.

Mehrotra noted at the meeting that almost two-thirds of retail clinic patients do not have a primary care physician.

In the study, Mehrotra and colleagues found that more than 90 percent of the retail clinic visits were for just 10 problems, including upper respiratory infections, pharyngitis, immunizations, otitis media, conjunctivitis, and urinary tract infections. Those same 10 conditions accounted for 18 percent of visits to primary care physicians, he said.

In another study still in press, Mehrotra and colleagues interviewed retail clinic patients to find out more about why they went to the clinics. For the uninsured patients, "one of the things that was a key driver of their going to the clinics... was the transparent pricing," he said. He said that one woman taking her son to the clinic told the researchers, "I could take him to a doctor but I would not know how much things would cost. But here the cost is up front."

Physicians Fight Back

Physician organizations, however, say that the retail clinics disrupt continuity of care and provide lower-quality care than physicians' offices or hospitals. In a 2006 policy statement, the American Academy of Pediatrics (AAP) said, "The AAP opposes [retail clinics] as an appropriate source of medical care for infants, children, and adolescents and strongly discourages their use, because the AAP is committed to the medical home model."

The policy statement went on to note that "Seeing children with minor conditions, as will often be the case in [a retail clinic], is misleading and problematic. Many pediatricians use the opportunity of seeing the child for something minor to address issues in the family, discuss any problems with obesity or mental health issues, catch up on immunizations, identify undetected illness, and continue strengthening the relationship with the child and family."

The American Medical Association issued a more cautious report on the clinics at its June 2006 annual meeting. In general, "the AMA supports free market competition among all modes of health care delivery and financing, with the growth of any one system determined by the number of people who prefer that mode of delivery, and not determined by preferential federal subsidy, regulations, or promotion," the association's Council on Medical Service said in its report.

The council added, however, that "there are some areas of obvious concern with the operation of such clinics, particularly as they relate to patient awareness, physician oversight, and continuity of care."

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