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 Retail medical clinics, first opened in the U.S. in
2000, have popped up in grocery stores, drug store chains and "big
box" stores. There were more than 6,000 such locations in the
country as of 2012, according to the policy update published in the
journal Pediatrics.
Representatives from Walgreens and CVS, both national drugstore
chains with associated medical clinics at some locations, largely
agree with the AAP guidelines and do not encourage people to use
their services as primary care.
"We strongly encourage all patients to have a relationship with a
primary care physician and medical home for ongoing medical needs
and routine exams," Walgreens spokesman Jim Cohn told Reuters
Health.
The statement only refers to the types of clinics that are built
into other businesses, not freestanding "urgent care" clinics, which
have also grown in popularity and have some of the same drawbacks.
According to the authors of the statement, taking kids to retail
clinics instead of primary care pediatricians fragments care, since
the kids don't always see the same medical provider. A child could
have chronic ear infections or other long-term medical problems that
seem to the providers at various retail clinics like unrelated
single events.
Pediatricians in "pediatric medical homes," Dr. James J. Laughlin
and his colleagues write, are more likely to notice patterns in the
child's health over regular visits. Laughlin is a pediatrician based
in Bloomington, Indiana.
Medical homes follow the traditional model of pediatric care, first
outlined in 1967, in which the family and primary care provider work
in collaboration for the child's medical and non-medical care,
holding all of the child's medical records in one central location.
In its statement, the AAP Committee on Practice and Ambulatory
Medicine also expressed concern that retail clinics may order tests
and fail to follow up. Or they may have cleanliness or public health
issues, given that ill people are congregating in a retail
environment not subject to the same sanitation standards as a
doctor's office.
The authors note that pediatric primary care doctors use visits for
minor ailments as an opportunity to explore more long-term subjects,
like diet and exercise, which probably do not come up at a retail
clinic.
The statement largely reaffirms the AAP's position from a similar
statement in 2006, which would otherwise have expired.
In the update, the committee says it still supports medical homes
and opposes using retail clinics as a source of primary care for
children. If communities need to use the clinics as a source of
acute care when their regular pediatricians are not available, there
should be a formal set of rules for a collaborative relationship.
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The clinics should adhere to all standards for pediatric care and
be subject to review by pediatricians, the update states. Also, all
information relevant to the clinic visit should be relayed back to
the pediatric medical home as soon as possible; if patients do not
have a regular pediatrician, the clinic should make arrangements to
establish one.
Lastly, retail clinics need formal arrangements for after-hours
coverage or emergency situations at the clinics.
Walgreens Healthcare Clinics, in some Walgreens drugstores, do use
evidence-based clinical guidelines and do seek to maintain
continuity of care at every point, Cohn said.
"Healthcare Clinics can play an important role in improving access
and bridging critical gaps in care in today's health care
environment," he said.
Dr. Andrew J. Sussman, president of MinuteClinic and senior vice
president/associate chief medical officer at CVS Caremark, agreed
that retail-based clinics can be useful.
"We really see our role as complementary to primary care providers,"
he told Reuters Health.
"I agree with the ideal that they set out for a retail-based
clinic," he said of the updated AAP statement. "I don't agree that
we are causing fragmentation of care."
CVS uses electronic health records or fax to send visit summaries to
pediatricians within 24 hours of each clinic visit, he noted.
"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."
Sussman believes CVS is already adhering to the guidelines laid out
in the statement and has been since 2006, though he would not speak
for other retail medical clinics. ___
Source: http://bit.ly/1kCYrQ1
Pediatrics, online Feb. 24, 2014.
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