Study: Retail health clinics as good as doc office

Alex Johnson Reporter • Profile

There is no evidence to back up doctors’ warnings that low-cost retail health clinics in hundreds of pharmacies and other stores across the country could expose customers to substandard medical care, researchers said this week.

The clinics, which operate under names like MinuteClinic, TakeCare and MediMinute, have become increasingly popular as convenient options for Americans seeking routine care without the expense of visits to doctors’ offices or hospital emergency departments.

More than 1,200 such clinics now dot the country since the first ones opened in pharmacies under the QuickMedX name (now MinuteClinic) in 2000, according to the Convenient Care Association, the industry’s trade group. A company called AeroClinic has even opened retail locations in two airports — Hartsfield-Jackson Atlanta and Philadelphia International — with plans to expand as early as this fall.

Some physicians’ groups, such as the American Academy of Pediatrics and the American Academy of Family Physicians, have raised concerns about potential conflicts of interest and the quality of care at retail clinics, where immunizations and treatment for routine illnesses like middle ear infections and sore throats are generally offered by nurse practitioners rather than doctors.

But the new research, the first large-scale study of the care provided in U.S. retail clinics, found “no difference in the quality offered to patients visiting retail clinics, physician offices and urgent care centers.” For some services, retail clinics even did slightly better than hospital emergency rooms, said the researchers, who published their findings in two papers this week in the Annals of Internal Medicine.

The studies are likely to add to the debate over controlling health care costs as President Barack Obama and Congress seek an agreement on a new health care system. The research, which was organized by the nonprofit Rand Corp., found that retail clinics charged significantly less for services commonly offered for several hundreds of dollars by doctors in private settings.

“These findings provide more evidence that retail clinics are an innovative new way of delivering health care,” said the lead author, Ateev Mehrotra, a physician and professor at the University of Pittsburgh School of Medicine. “Retail clinics are more convenient for patients, less costly and provide care that is of equal quality as received in other medical settings.”

Clinics not available to everyone
If anything, the authors said, the biggest concern about retail clinics — more than 400 of which are operated by Wal-Mart Stores Inc. alone — is that there aren’t enough of them.

Academy of Family Physicians responds Dr. Ted Epperly, president of the American Academy of Family Physicians, submitted this response to the Rand Corp. study: This article highlights two recent studies by the Rand Corporation claiming that care delivered at retail health clinics is as good and is less expensive than care received in a doctor's office. Unfortunately the article and the studies it highlights may misinform your readers. The studies draw a very broad conclusion even though they included patients from only one state. Furthermore, they compared care for only three common complaints: sore throat, urinary tract infection and earache. Out of the thousands of medical problems patients experience everyday, these three often simple diagnoses should not be used to draw such broad conclusions about the overall quality and cost of medical care received. The retail health business model is an over-the-counter medication aimed at temporarily treating only one symptom of an ailing health care system. Patients are at risk when they seek services from a health care provider who is not familiar with their medical history, health risks, and other vital information. The American Academy of Family Physicians believes retail health clinics can complement the work of family and other primary care physicians. However, they cannot replace a trusted personal physician who is familiar with a patient's medical and family history, provides and coordinates care over a spectrum of conditions with other health care professionals, and can perform much more sophisticated testing, diagnosis, treatment and procedures when appropriate. Ted Epperly, MD, FAAFP President American Academy of Family Physicians

Nearly half of all retail clinics are concentrated in just five states — Florida, California, Texas, Minnesota and Illinois — while 18 states have none at all. As a result, less than a third of Americans live within a 10-minute driving distance from one, the studies found.

For patients who can get to one, a retail clinic offers several advantages over visits to traditional doctors’ offices or urgent care centers.

Nearly all of them accept major insurance plans, and because they are usually attached to pharmacies, patients can fill their prescriptions immediately. Meanwhile, the costs for routine procedures like flu shots, sore throat exams and cholesterol screenings are significantly lower — an average of $110, compared with $166 for doctors’ offices, $156 for urgent care centers and $570 for hospital emergency departments.

To track the quality of care, the researchers studied outcomes for three routine illnesses — middle ear infections; pharyngitis, or a sore throat caused by inflammation of the pharynx; and urinary tract infections — for hundreds of patients each at doctors’ offices, urgent care centers, hospital emergency rooms and MinuteClinic retail clinics in Minnesota.

They recorded no significant differences in patient outcomes except in emergency departments, where prescription costs were higher and quality scores were significantly lower than in the other settings.

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Researchers say doctors’ fears unfounded
As a result, the researchers found “no evidence to support the concerns” of physicians groups that retail clinics might be likely to overprescribe antibiotics or overlook some conditions because doctors are not conducting examinations.

In 2007, the American Academy of Family Physicians issued a statement raising those and other questions — including concerns about disrupting the traditional doctor-client relationship — and stressing that “the Academy does not endorse these clinics.”

Three years ago, the American Academy of Pediatrics raised similar objections in a policy statement in which it said it “strongly discourages their use.”

Mehrotra, the studies’ lead author, acknowledged doctors’ concerns and said “we need to continue to examine retail medical clinics as they grow in number.” But he said “the results we have seen thus far” suggest that retail clinics do “provide high-quality care in a convenient and cost-effective fashion.”

Co-author Marcus Thygeson, medical director of HealthPartners Inc., a Minnesota health maintenance organization unaffiliated with MinuteClinic, agreed, saying the research should be “reassuring to consumers.”

While retail clinics offer a limited set of services, “the price is affordable and the quality — at least at MinuteClinic — seems to be as good as you would get in the average doctor’s office,” he said.

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