Physicians News Health news for doctors and patients.
By Alan Lyndon
If your child is sick and needs medical attention, a local pediatrician is better than the corner drug store clinic. That’s the message from the Amercian Academy of Pediatrics (AAP), which issued a policy statement that retail based clinics (RBCs) are an inappropriate source of primary care for children.
According to the AAP, retail clinics “fragment medical care and are detrimental to the medical home concept of longitudinal and coordinated care.”
Retail based clinics — also known as convenient care, urgent care, or walk-in clinics — are often located in popular drug store chains and big box retailers. Since the first RBC opened in 2000, the industry has grown to more than 6,000 clinics across the U.S. The appeal of the RBC to patients is often one of convenience. They can be easier to access, easier to see a provider, quicker in-and-out, and potentially lower costs.
Even families with established relationships with a pediatrician frequent retail clinics. A study published in JAMA Pediatrics found that 74 percent of parents surveyed “first considered going to the pediatrician, but reported choosing an RC [retail clinic] because the RC had more convenient hours (36.6 percent), no office appointment was available (25.2 percent), they did not want to bother their pediatrician after hours (15.4 percent) or they thought the problem was not serious enough (13 percent).”
The AAP opposes the lower costs and financial incentives often found at RBCs. Retailers like Walgreen’s, Target, Wal-Mart and CVS are able to negotiate more favorable rates with payers due to volume or offer to patients incentives in the form of in-store gift cards. These incentives are enticing to patients and can not be replicated at the doctor’s office.
RBCs are often staffed only with physician assistants or nurse practitioners lacking in formal pediatric training. The continuity of care received at a pediatric medical home can not be replicated at a retail clinic. “There is no such thing as a ‘minor illness’ when it comes to children,” says the AAP. “Pediatricians use these ‘minor illness’ visits to identify other, potentially more serious issues.”
The AAP believes that pediatric care should follow a more traditional medical-home model as opposed to the fragmented system of convenient care centers. However, opportunities for collaboration exist so long as the clinics agree to: use of evidenced-based pediatric protocols and standards; pediatric quality review; prompt communication with the primary pediatrician; and formal arrangements for after-hours coverage or emergency situations that may occur during a patient visit to an RBC.
