March 16, 2017
That depends on who you ask. The longitudinal primary care community has publicly expressed concerns that retail clinics disrupt the continuity of care so they lean more towards “foe”. Hospitals and health systems in the past looked at non-affiliated retail clinics as competitive threats but for many now, these clinics are clearly a “friend” because, through partnership relationships, they allow a system to extend their geographic reach and gain new patients.
In my opinion retail clinics are like the fast food of healthcare. While that might be a harsh descriptive, the reality is that there are some analogies. Think about the similarity of the key messages of retail health clinics and fast food chains. Walk-in convenience, no appointment/reservation necessary, short wait times, low cost. Long term “nutritional value” (i.e. quality) seems to have taken a back seat to convenience in both sectors.
And that’s where I see the difference between the episodic nature of retail clinics and primary care. Retail clinics focus only on the acute issue. Primary care focuses on the overall healthcare needs of the patient, looking for underlying issues associated with the acute problem while also taking the opportunity to provide counsel related to wellness, life-style modifications, prevention and recommended screenings.
Primary care is a personal relationship rather than a consumer encounter. Every patient-physician visit provides the opportunity for each party to get to know each other better, develop trust and build a long-term relationship and game plan for wellness. I get that we live in an “ATM convenience” world but fear that the emphasis on convenience can erode the patient-physician relationship and ultimately negatively impact patients. Consider the onset of a chronic illness. Would you rather have your care coordinated by a physician partner that you have had a relationship with or would you be willing to have a retail clinic provider be your navigator? I think the answer is obvious.
Continuity of care will keep a person healthier as they age. PCPs gain valuable information from tracking a problem or condition over time and can make treatment decisions accordingly. Over the long term a provider that knows your health history, habits and personality can recognize signs indicating a potential change in health. Should you need a specialist, the PCP will refer you to someone that they have a collaborative relationship with and will keep track of your care with the specialist by serving as the captain of your care team. They will educate you to prevent chronic disease down the road. In short, they know more about your health than any other provider. (1) Here’s an example of the benefit of continuity of care and the potential to miss larger issues by going to a provider where no personal relationship exists. A woman with a sore throat went to a retail clinic and received a prescription for an antibiotic. After a few days, feeling better, she went to her family physician. The physician determined that the sore throat was probably due to a viral infection (and not requiring antibiotics). He also talked to her about her overall health and life. The conversation led to a previously unsuspected diagnosis of clinical depression. (2) Primary care looks at the big picture of a patients’ health. This cannot be duplicated in a visit to a retail clinic provider that has no relationship with a patient.
Concerns Regarding Continuity Of Care
Organizations like The American Academy of Family Physicians (AAFP) and The American Academy of Pediatrics (AAP) have publicly expressed concerns about retail clinics and their negative impact over continuity of care and its effect on the Medical Home, a model of primary care that is comprehensive, patient-centered, team based, coordinated, accessible and focused on quality and safety. (3) In fact the AAP has stated that the structure and function of retail clinics is not driven by the Medical Home model and have expressed concerns related to:
- Fragmentation of care
- Possible decreased quality of care
- Lack of access and maintenance of a complete central health record that contains all pertinent patient information
- Use of tests for the purpose of diagnosis without proper follow up
- Public health issues when patients with infectious disease are in a retail setting
- The lack of using the acute visit to address issues in the family such as obesity, mental health and immunizations to continue building the relationship with child and family
While the AAP continues to oppose retail clinics as a source of primary care for pediatric patients, it recommends if pediatricians and the Medical Home wish to utilize retail clinics to expand access for acute care, it will require a formal, collaborative relationship which includes at the very least:
- Evidence-based protocols and standards
- Pediatric quality review
- Prompt communication for all visits of patients to the retail clinic
- Referral of patients back to the Medical Home
- Arrangements to establish a Medical Home for patients who do not have one
- Formal arrangements for after-hours coverage or emergency situations that arise during a patient visit to a retail clinic (4)
Fueled by access and convenience, retail clinics have experienced explosive growth and are here to stay. (See Commoditizing Primary Care) You can pick up your soap, toothpaste and cereal and then head down aisle five to see what’s on the healthcare menu. Pretty convenient. But I think we need to question the long term “nutritional value” of retail clinics (i.e. quality and continuity of care) in relation to what primary care medicine brings to the table.
Chief Operating Officer
Northwest Physicians Network
Coming Next: Health Systems Walk-In Clinic Strategy Threatens Private Practice Primary Care
- The Case For Having A Primary Care Physician”, One Medical Health News, March, 2011
- The Case Against Drugstore Clinics”, The Atlantic, October, 2014
- Healthcare on Aisle 5-The Rise Of The Retail Clinic”, Toshiba Medical, September, 2015
- Policy Statement: AAP Principles Concerning Retail-Based Clinics