SMALL IN SIZE, RETAIL CLINICS SCORE BIG ADVANTAGES FOR PATIENTS

Two-thousand and eight has been an off-year for convenient care clinics.The industry figures to wrap up its year-end expansion at a paltry 85 percent growth.Yes,paltry. The number would mark an enviable success,of course,by nearly anyone else’s standards,but it is somewhat ho-hum for this emerging network of bite-size healthcare facilities.

Such is the state of affairs when an industry roars from 2006 to 2007 at a breakneck clip of 400-percent growth.Eighty-five is suddenly mundane.

In the eight years since their establishment — MinuteClinic,the first convenient care clinic, opened its doors in 2000 in Minneapolis-St.Paul — these clinics have executed sustained growth while delivering care that has achieved overwhelming levels of patient satisfaction. Industry experts expect the total number of clinics to push 1,600 by year’s end.

A recent study from WSJ.com/Harris Interactive found that 30 percent of patients who visit retail clinics do not have a primary care provider. While retail clinics can fill the gap in healthcare access for uninsured, they can also — and, by their regulations, must — promote the use of traditional care.

Convenient care clinics,in short,are healthcare facilities located in retail outlets,such as big-box stores and supermarkets.CVS and Target,among others,have their own brands. They are staffed by nurse practitioners or physician assistants,and are meant to provide care for patients with minor conditions,such as a sore throat,an ear infection or bronchitis, or to administer vaccinations or,more recently, physical examinations.

Strong evidence points to a permanent place for these clinics in the increasingly diversified spectrum of healthcare delivery.The question is:Is health care ready to embrace them?

Establishing Common Ground

The summer of 2007 brought some challenging publicity to the retail clinic industry.The American Medical Association,the nation’s largest physician’s organization,called for investigations into potential conflicts of interest having to do with store-based clinics and the encouragement of patients to fill prescriptions at on-site pharmacies.It was also reported that a small number of the AMA’s member physicians called for a ban on convenient care clinics altogether.

This opposition was the result of general “misconceptions”about the very nature of the emerging industry,according to Tine Hansen- Turton,executive director of the Convenient Care Association (CCA),a Philadelphia-based trade group that represents about 95 percent of retail clinics across the country.

“Early on,there was not really an understanding of what the clinics are and what they are not,” she says.“Initially it was believed that these clinics would be medical homes.That was never the intent.”

Instead,Hansen-Turton says,the CCA has made it a point to reinforce its role within the medical industry.She saw the AMA’s initial response to the growing number of retail clinics as sign of apprehension.“The concern was really,is this going to take away the work of primary care?”

It is not designed to,and there seems to be no delusion among the ranks of CCA that it will. Instead,members of the CCA see their role as a basic enhancement to the medical home.In fact, as it continues to take measured strides toward integration,the CCA has adopted official quality and safety standards,one of which commits members to encourage patients to establish a relationship with a primary care provider.

The limited scope of retail clinics is meant to provide accessible care not instead of — but in addition to — primary care.Have an earache or another non-debilitating condition that you would like to get cleared up during a trip to the grocery store? In such a scenario a clinic is a fitting choice.In fact,the most important benefit of these clinics,according to patients, is the matter of convenience.The story behind the naming of CCA speaks for itself.

Prior to its establishment in 2006 there was a debate about which flagship word attached to its name would best represent the industry. Words like “accessible”and “quality”were put forth only to be cast aside as patients consistently listed the number-one benefit — convenience — that ultimately gave the trade group its name.“It fits within a very busy lifestyle,and that’s what people take away with these clinics,”says Hansen-Turton.

Yet the sake of convenience does not necessitate a sacrifice in quality.A study published in the American Journal of Medical Quality last year reveals a high level of care,while simultaneously skewering — in this case — the lingering con- flicts-of-interest claims of the AMA.Analyzing cases of acute pharyngitis,or sore throat,in more than 57,000 patients at MinuteClinics in Minneapolis and Baltimore from September 2006 to September 2007,the study depicted rates of adherence to clinical guidelines to be nearly flawless,at 99.15 percent.Furthermore, the study showed that overprescription was essentially a non-factor.Of the 39,350 patients who produced a negative strep test result,just .95 percent received an unnecessary prescrip- tion,far below nationwide data suggested by other studies.

And instead of infringing on primary care,retail clinics can act as a bridge toward a greater usage of the medical home model.A recent study from WSJ.com/Harris Interactive found that 30 percent of patients who visit retail clinics do not have a primary care provider.While retail clinics can fill the gap in healthcare access for unin- sured,they can also — and,by their regula- tions,must — promote the use of traditional care.