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Clinics still face some resistance

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NEW YORK — In-store health clinics are becoming increasingly popular with retailers and their customers, who see them as more convenient and less expensive than doctors’ offices. But not everyone is welcoming retail clinics’ rising popularity.

Such clinics — located in drug stores and other retail outlets — are typically open seven days a week and don’t require appointments. They often accept more types of insurance than doctors’ offices do, and they charge less for comparable services.

The first retail-based clinic opened in 2000 in the St. Paul/Minneapolis area. By 2012 there were about 1,400 such outlets in the United States, according to Accenture, which predicts that the number will grow to as many as 2,800 by next year.

To the American Academy of Pediatrics (AAP), that growth trend is problematic. The doctors’ group contends that retail-based clinics are not appropriate sources of primary medical care for children.

In an update to its 2006 policy statement, the AAP stressed the importance of young patients having a “medical home,” involving an ongoing relationship with a personal physician who is responsible for all aspects of the patient’s care.

Retail-based clinics “challenge this medical home concept by offering care that is arguably more convenient and less expensive but also fragmented, episodic and not coordinated,” the AAP argued in an article in the March 1 issue of the journal Pediatrics.

The AAP notes that clinics are generally staffed by physician assistants or nurse practitioners who do not have a pediatrician’s training and are not available after hours to handle questions from the patient or family or to respond to complications.

“As pediatric patients and their health issues become more complex, the concern exists that even a child presenting with a simple complaint may have a more serious unrecognized condition,” the article, whose lead author was Dr. James Laughlin, argued.

The article also complained about “scope-of-care creep” within the retail-based clinic setting, with the facilities now offering services beyond treatment for sore throats or ear infections, including providing childhood immunizations and school and sports physicals.

“These offerings impinge on core preventive care services of the pediatric medical home and are misperceived by patients and families as an appropriate substitute for regular preventive care within the medical home,” Laughlin wrote.

Convenience Care Association executive director Tine Hansen-Turton counters that clinics can fill the gap when a child’s pediatrician is not available, offering an alternative “to waiting for an appointment while the child is sick or spending hours in a high-cost emergency room for a minor pediatric complaint.”

Dr. Andrew Sussman, president of MinuteClinic and senior vice president and associate chief medical officer at CVS Caremark Corp., agrees that retail-based clinics meet a need.

“We really see our role as complementary to primary care providers,” he told the Reuters news service, adding that although he agreed with the ideal the AAP has suggested for a retail-based clinic, he did not agree that such clinics are causing fragmentation of care.
“We strongly support the medical home,” he said. “We sometimes see kids who do not have pediatric medical homes, and we give parents a list of nearby pediatricians.”


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