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      Retail Clinics Provide Low-Cost, Quality Care

      Study finds clinics on par with doctors’ offices, emergency rooms

      Looking for affordable health care with proven quality, minimal wait times and high patient satisfaction? Maybe you should head to the store. Retail clinics—small exam rooms in stores like CVS, Rite Aid, Target and Wal-Mart—provide low-cost care that is equal to or better than that received in physicians’ offices, urgent care centers and emergency rooms, according to a care comparison study published in the Annals of Internal Medicine.

      The study by the nonprofit Rand Corp. found that even though the care was comparable, the costs of care in retail clinics were 30 percent to 40 percent lower than in physicians’ offices and urgent care centers and 80 percent lower than in emergency rooms.

      Staffed by nurse practitioners and physician assistants who diagnose and treat routine ailments like sore throat, sinus infection and ear infection, retail clinics have grown in popularity since the first one opened in 2000. But some doctors’ groups, including the American Medical Association, question whether the clinics provide adequate care. They have warned that retail clinics may prescribe more antibiotics because many clinics are run by stores that profit from drug sales. But the study, published Sept. 1, found no significant difference in the number of prescriptions written by clinics, doctors’ offices or emergency rooms.

      “These clinics are filling a niche of really convenient care,” says Ateev Mehrotra, M.D., the study’s lead author and a professor of internal medicine at the University of Pittsburgh School of Medicine. Many people have trouble getting a doctor’s appointment and often have to carve out hours to see a physician due to wait times at doctors’ offices. Retail clinics, on the other hand, he says, offer “walk in, no appointment, easy” access to professional medical care for many routine illnesses and are open evenings and weekends. Mehrotra is also a researcher at the Rand Corporation.

      Walk in and say “ah”

      He and his fellow researchers examined 700 cases each of three common illnesses—sore throat, ear infection and urinary tract infection—treated at retail clinic locations in Minnesota, and compared each of those cases with cases of the same illness treated in doctor’s offices, emergency rooms and urgent care centers. The study looked at costs of visits, performance judged by 14 quality measures—such as whether sore throat patients got rapid strep tests—and whether patients received seven preventive-care services—such as cholesterol testing and high blood pressure tests—at the initial visit or during the next three months.

      “It is drummed into us as doctors that when a patient comes to see you,” Mehrotra says, “you’re supposed to say, ‘You’re missing these tests, why don’t you come back within three months.’ ” He said he expected to find less preventive care in retail clinics because the staff there wouldn’t have each patient’s medical history. “But we found people were just as likely to get preventive care in retail settings” as in the other settings, Mehrotra says. The study looked at three months’ worth of records for each case to verify whether patients received the recommended tests.

      Targeting patients over 50

      Ted Epperly, M.D., president of the American Academy of Family Physicians, says although there is a role for retail clinics when patients cannot get in to see their doctors, clinics are not a viable replacement for a primary care physician. “These shouldn’t be seen as the new place to go.” He added that elderly patients especially often have multiple chronic conditions. “To say [retail clinics] are just as good doesn’t quite reflect the complexity” of a patient with multiple health issues.

      In part because services are limited, the clinics tend to attract young adults, Mehrotra says. “Most older adults have established relationships with their primary care providers, and many of the patients have chronic health conditions that they’d prefer to address over time with one doctor or team of doctors.” Young adults, in general, are busier and place a higher premium on convenience and efficiency.

      In the study, the vast majority of patients with ear infections and sore throats were under age 44, and none was older than 64. For urinary tract infection, 30 percent of patients were ages 45 to 64; three patients were 65 or older.

      Retail clinics may soon become more attractive to older consumers: MinuteClinic, owned by CVS Caremark, plans to begin treating chronic conditions like high blood pressure and diabetes within the next year, says MinuteClinic President Andrew Sussman, M.D. The retail-clinic model can work well for these long-term conditions, he says, as long as the nurse practitioners follow specific guidelines.

      “We also feel there’s a lack of access to primary care for many patients,” and that many would welcome another option to help them manage their diseases, Sussman says.

      Clinics cost hundreds less

      The mean cost for all patient visits (excluding drugs, tests and hospitalizations) was $66 for retail clinics, nearly 40 percent less than the cost for doctors’ offices ($106) and urgent care centers ($103), and about 82 percent below emergency rooms ($358). Costs for lab and imaging services were also significantly lower: Retail clinics charged about half of what doctors’ offices and urgent care centers charged, and about 87 percent less than the cost at emergency rooms. Prescription costs were similar for retail clinics, physician offices and urgent care centers, and about 20 percent higher for emergency rooms.

      Retail clinics keep costs down by hiring nurse practitioners, who draw lower salaries than doctors, and by sticking to a narrow range of routine diagnoses, treatments and services, Sussman says. He says 80 percent of visits to MinuteClinic are covered by insurance; that is about average for retail clinics nationwide.

      Convenience for patients is no small part of their high patient satisfaction rate, Sussman says. “If you have a sore throat on a Sunday afternoon you can get to a MinuteClinic and be seen in 15 minutes. It’s hard to get that in other settings.”

      About one-third of the U.S. population lives near a retail clinic, which are mostly in urban areas, according to a related study that was also published in the Sept. 1 issue of the Annals of Internal Medicine. Both studies were funded by the California HealthCare Foundation, an independent group based in Oakland, Calif.

      John Briley writes about health, fitness and travel.

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