En español l Clinics in drugstores and big-box retailers have given flu shots and treated runny noses for years. But Walgreens' Take Care Clinics upped their game this spring when they began to diagnose, treat and manage care of hypertension, diabetes and other chronic conditions.
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Two trends are helping drive this expansion of services: a shortage of family doctors — the U.S. could easily put another 16,000 of them to work in underserved areas, according to the Health Resources and Services Administration — and the increase, by an estimated 30 million, in the number of patients who will get insurance coverage under the new health care law, making the physician shortage even worse.
Here are answers to some questions you may have about retail clinics.
What are "retail clinics"?
Tucked inside your pharmacy or big-box chain, retail clinics provide basic, drop-in medical care, in many cases seven days a week. More than 1,400 retail clinics are found in drugstores, groceries and chains such as Target and Walmart. CVS has MinuteClinics; Rite Aid has NowClinics; and three grocery store chains in six states contain Little Clinics. According to a 2009 Rand Corp. study, about one-third of Americans live within a 10-minute drive of a retail clinic.
What services do retail clinics provide?
Vaccinations, checkups, blood tests and care of such nonurgent problems as rashes, sore throats and earaches are typically handled in these settings. This spring, Walgreens broke that mold by starting to diagnose (it used the word "assess"), treat and manage chronic health conditions. Retail clinics hadn't been in that business before.
Who treats patients at a retail clinic?
The clinics are staffed by nurse-practitioners and physician's assistants, not doctors. The training of nurse-practitioners goes beyond a typical nurse's education to include a graduate degree. In California, the state government is considering legislation to expand the responsibilities of nurse-practitioners, allowing them more independence.
A recent survey published in the New England Journal of Medicine asked doctors and nurse-practitioners about their roles and whether, for example, they should be paid the same for providing similar services to patients. Not surprisingly, the survey found a strong divergence of opinion in the two groups — with doctors and nurses disagreeing about everything from the level of care nurse-practitioners should be allowed to provide to how much they should be paid for it.
What are the costs and will my insurance pay for the care? What about Medicare?
One of the advantages of retail clinics over some other medical settings is that prices for services are often posted at the clinic and online. A tuberculosis test at MinuteClinic costs $39. At NowClinics, a 10-minute virtual visit with a real doctor, whether online or on the phone, costs $45.
According to the MinuteClinic and Take Care websites, they accept most insurance plans. But not all do: According to the Rite Aid website, "Services provided via NowClinic online care are not submitted … to your health coverage plan, Medicare, or any state Medicaid program for reimbursement." This means you will pay out of pocket for care. Check with your insurance company and the clinic before you start your visit.
What is the main concern of doctors questioning the new Walgreens approach?
Critics wonder whether the expansion of services in retail clinics means that patients with a chronic condition who seek affordable, convenient care will end up forgoing quality, coordinated care. If nurse-practitioners at Walgreens are managing chronic diseases, "having a piece of your blood pressure checked here or your diabetes checked over there means that nobody's taking care of the whole person," says Jeff Cain, M.D., president of the American Academy of Family Physicians.
"You miss the opportunity to do prevention, to do diet counseling, to make sure that the diabetes and the blood pressure and heart failure that are complex issues [are] managed together," he says.
How do nurse-practitioners respond to doctors' concerns?
Anne Norman, associate vice president of education of the American Association of Nurse Practitioners, counters that nurse-practitioners are indeed treating the "whole person" in retail settings. She says they work to "involve the patient in developing an appropriate plan of care" and concentrate on evidence-based care for the "best patient outcome." Just like doctors.
Alan London, M.D., chief medical officer at Take Care, says he stands by the training of his board-certified nurse-practitioners. For the 40 percent of patients who have no primary care doctor, the staff tries to refer them to one, London says. Having trained side by side with nurse-practitioners, he concludes, "They're wonderful at providing this kind of care."