Study Examines Role of Retail Health Clinics

As the number of retail health clinics swells to more than 1,000 nationwide, new research suggests that the clinics may be emerging as safety net providers for patients who don't have a usual source of health care.

The study, "Retail Clinics, Primary Care Physicians, and Emergency Departments: A Comparison of Patients' Visits," was conducted by the Rand Corp. and published in the September/October Health Affairs.

Researchers focused on data provided by retail clinic companies that are members of the Convenient Care Association, a Philadelphia-based organization founded in 2006 to represent retail clinics. The companies submitted de-identified data on all clinic visits through the summer of 2007.

The study focused on the demographic characteristics of patients and the conditions for which they were being seen. Researchers found that

The data show that immunizations top the list of preventive services rendered in retail clinics. The study authors noted that because U.S. immunization rates continue to be low, retail clinics may offer a new venue for helping to increase them.

The study also questioned whether retail health clinics interfere with primary care relationships. Researchers noted that nearly 60 percent of retail clinic patients reported that they did not have a primary care provider, "so for these patients, there is no relationship to disrupt."

Study authors concluded "most of the conditions cared for in retail clinics likely do not require the level of training of a physician." Furthermore, said the authors, retail clinics could be filling a health care gap in light of a shortage of primary care providers and overburdened emergency departments.

(Then) President Jim King, M.D., of Selmer, Tenn., pointed out that the study did not address an issue of utmost importance to the Academy, namely, the quality of health care at retail clinics, which is delivered primarily by nurse practitioners.

He agreed that retail health clinics play a role in treating patients with minor medical problems. However, he added this caveat: "Retail health clinics will never take the place -- and should never take the place -- of the patient-centered medical home. But they can serve as a mechanism to get patients into the health care system and get patients the short-term, acute care they need."

King said retail clinics should function under the Academy's list of desired attributes. "When a patient comes in for a minor health problem and needs further care, retail clinics should have a ready network of primary care physicians available for referrals," said King. "Mid-level providers need supervising physicians to help them with those patients whose conditions go beyond the clinics' limited scope of practice."

Lead author of the study Ateev Mehrotra, M.D., assistant professor at the University of Pittsburgh School of Medicine and a research analyst at the Rand Corp., said the study may help calm physicians' fears that retail clinics are expanding their scope to include chronic illness and complex medical problems. "The fact that we found the vast majority of care is for these relatively simple conditions might be reassuring to the physician community," he said.

Mehrotra, board certified in internal medicine and pediatrics, speculated that the study's hard demographic and usage data on retail clinics may help change physician perceptions about retail clinic services. Eventually, physicians may see that retail clinics complement the services primary care physicians provide rather than compete with them, he said.

Tine Hansen-Turton, executive director of the Convenient Care Association, said the study affirmed the value of retail clinics. The data show that retail clinics offer affordability and accessibility to patients, said Hansen-Turton, "especially in parts of the country where patients experience gaps in available health care services."