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Member Research and Reports

Arizona Professor Reviews the Shift in Retail Clinics from Episodic Acute Care to Partners in Coordinated Care

Dr. James E. Dalen, professor emeritus from the University of Arizona Mel and Enid Zuckerman College of Public Health and the UA College of Medicine writes about the shift in retail clinics from contributing to fragmentation of care to the possibility of becoming partners with medical homes to offer coordinated care. Dr. Dalen’s commentary is published in The American Journal of Medicine.

The first retail clinic, offering care for common acute medical conditions, opened in a grocery store in Minneapolis in 2000. By 2015 there were 1900 retail clinics in the United States. Some have estimated that there will be 3000 retail clinics located in drug stores, grocery stores, and “big box” businesses by the end of the year.

The majority are operated by 2 drug store chains: CVS (MinuteClinics) and Walgreens (Take Care Clinics). Retail clinics are responding to a market failure in the United States: the lack of a rapid, convenient access for patients with minor medical problems, especially at night, and on weekends. They are designed to treat a limited number of common acute conditions. Upper respiratory infections account for 61% of visits, and vaccinations or preventive examinations 22%.

The top 10 diagnoses account for 90% of all visits. Each of these conditions has widely accepted treatment guidelines, and they do not require follow-up visits. Treatment is by nurse practitioners or physician assistants. Patients with conditions that fall outside their scope of practice (less than 5% of visits) of care are referred to a physician office or an emergency room. The patients tend to be young (aged 18-44 years), more women than men, and 20%-30% are uninsured. Thirty percent to 60% do not have a primary care physician.

The number one reason patients go to retail clinics is convenience. Appointments are not needed; one does not have to miss work or school. These clinics are easily accessible and are open after hours and on weekends.

The most frequent criticism is that retail clinics fragment care, interrupt continuity of care, and lack coordination with the rest of health care. As noted, 30%-60% of retail clinic patients do not have a primary care provider, making coordination of care problematic. Some clinics have effective relationships with local primary care providers. Electronic medical records permit transmission of records to a patient’s primary care provider if the patient agrees.

New collaborations such as with Henry Ford and Kaiser Permanente have a dramatic impact on the role of retail clinics. Many are shifting from offering episodic acute care to becoming an integral part of health care systems offering continuing coordinated care. Patients in the health system benefit by receiving some of their coordinated care from the health care organization at a retail clinic close to their home at their convenience. The retail clinic has shifted from contributing to fragmentation of care to the possibility of becoming partners with medical homes to offer coordinated care.

Link: http://www.amjmed.com/article/S0002-9343(15)00825-6/fulltext

Retail Clinics: A Shift From Episodic Acute Care to Partners in Coordinated Care

The American Journal of Medicine, Feb 2016