Doctors urge caution when using retail-based clinics - Tucson News Now

Doctors warn against retail clinics

You've seen them in stores like Walgreens, Kroger and Walmart. They are called limited services clinics, and they offer immediate care for minor medical problems.

"We have a wide variety of services," says Jill Johnson, an experienced nurse practitioner who manages the Take Care Clinics in the Louisville, Ky. area. "We see acute illnesses like strep, ear, nose and throat; we can do sports physicals and school physicals."

"If you have an earache and your doctor can't see you today, emergency room's going to cost you $500, whereas you can come over here and if we don't have to do any tests, it's going to cost you anywhere from $69 to $79 depending on if it's your first visit."

But some doctors say you should be cautious in choosing these types of clinics for your medical care.

"These minute retail clinics are a convenience for consumers, they provide diagnoses for simple diseases usually, but there are some disadvantages," says Dr. John Roth, a pediatrician. "Where they may have an advantage is on price. The charge for an earache or strep throat may be less than what your doctor might charge."

However, Roth says there are other considerations.

"But on the other hand, the continuity of care, the knowledge about you as a person is limited,; you're walking in off the street cold," Roth says. "They know nothing about your background and consequently errors can be made."

And according to Roth, knowing something about you is important. 

"History is so important," Roth says. "If you have a history of certain drug allergies or you have a cross reaction with a medication that you might be taking and I would prescribe the wrong medication, the chances are I'm going to have that knowledge because it's going to be in your record that I have in my hand. The nurse practitioner at a minute clinic has no knowledge of what you've had in the past and might inadvertently give you something that's different that shouldn't be given."

The issue has become so significant, that the American Academy of Pediatrics issued a policy statement in 2006, then again in March of 2011. It reads:

"The American Academy of Pediatrics (AAP) opposes retail-based clinics (RBCs) as an appropriate source of medical care for infants, children, and adolescents and strongly discourages their use, because the AAP is committed to the medical home model. The medical home model provides accessible, family-centered, comprehensive, continuous, coordinated, compassionate, and culturally effective care for which the pediatrician and the family share responsibility.1 Given that the RBC is not a medical home model, the AAP is particularly concerned with the effects of the following attributes of an RBC on health care for children and adolescents:

Fragmentation of care.

The possible effects on quality of care.

Provision of episodic care to children with special health care needs and chronic diseases, who may not be readily identifiable.

Lack of access to and maintenance of a complete, accessible, central health record that contains all pertinent patient information.

The use of tests for the purposes of diagnosis without proper follow-up.

Possible public health issues that could occur when patients with contagious diseases are in a commercial, retail environment with little or no isolation (e.g., fevers, rashes, mumps, measles, strep throat, etc).

Seeing children with "minor" conditions, as will often be the case in an RBC, is misleading and problematic. Many pediatricians use the opportunity of seeing the child for something minor to address issues in the family, discuss any problems with obesity or mental health issues, catch up on immunizations, identify undetected illness, and continue strengthening the relationship with the child and family. These visits are important and provide an opportunity to work with patients and families to deal with a variety of other issues. "

The clinics are regulated by the state. Each state varies in it's requirements. In Kentucky, the clinics can't treat children younger than 24 months, must list the services they provide and the fees they charge for those services, and they must make it clear to the patients that they are under no obligation to buy any recommended or prescribed item from the host store. Some states allow the clinics to treat children as young as 18 months.

"We don't follow chronic problems," Johnson says. "So you need a medical home. Most patients do, but if your medical provider is out of town or they're too busy and you just have a sore throat, need your ear looked at, need your ear cleaned out - their office may be too busy to get you in today. You can come over here and we could get you in."

Roth puts it this way: "The main advantage is price and convenience. But there are a lot of doctors' offices that have walk-in appointments and if you want to know the price of what your doctor's charging, most any of them are more than willing to let you know what the cost is. But most people don't care, because 'their insurance pays for it.' So they don't care what these things cost; they just want it done."

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