Tuesday, September 15, 2009

Retailer-based clinics

An article in the Washington Post today discussed an article from the journal called the Annals of Internal Medicine in which the authors evaluated the cost and quality of care for three common acute illnesses at retailer-based clinics. These are clinics at Wal-mart, Target, CVS, and other retailers. What did they find? That at least for these three conditions the costs are lower and the quality is at least as high as at physicians offices. In addition, the costs are much lower than at emergency departments.

So, if we can get good care from these types of providers (who are often nurse practitioners rather than physicians) at a lower cost with short waiting times, should we all skip care from our primary care provider the next time we need care and just go to the local drug store or discount store? Before I answer that question, let me point out that both the Washington Post and the original research report in the Annals of Internal Medicine were careful to point out that only three acute and common conditions were examined. So, we should not generalize this finding to all conditions.

Despite that, I would say that I'd be very comfortable going to a retailer-based provider or other similar provider the next time I need care. For me, the fact that I have not seen a physician in years, the short waiting time, and the fact that most things I am likely to have in the near future are acute conditions helps me to make that decision. My wife's had a recent experience with an internist's office that we'd been to years ago. They could not even find us in their system when she called. That was enough to demonstrate to me that our primary care system can be lacking in some cases.

Do we have any reason to pause? Yes. Obviously, we don't always know in advance whether the presenting condition is a common acute condition or something else. For example, we were almost certain my 13 year old had some type of influenza last week but tests came back completely negative. Fortunately, he recovered. Sometimes, things other than common acute conditions need to be considered. Retailer-based clinics may have a different level of quality in such cases. Also, for a patient who needs frequent care with a lot of follow up, the value of continuity of care has long been discussed. That may not be achieved easily in a retailer-based setting.

So, as usual in this blog, it is a matter of tradeoffs. Today's article in the Washington Post simply suggests that the tradeoff of convenience and cost savings with a loss of continuity may not be such a bad tradeoff. of course, if everyone reaches that conclusion, the shorter waiting times may not always exist. That's a matter for another day's discussion.


  1. Dr. Frick well put. I believe you are correct about the use of convenient care clinics in an acute non threatening situation. The question is why can't we get health care visits and preventive care as well as follow up care right? It is a sad situation when the physician or staff do not know or remember you? Let's see will informatics improve this endeavor? It has to be the right system and be able to function, not like our hospital where they upgraded the information systems and my computer crashes at least 5 times a day. Love the blog. See you Friday

  2. I thought I had responded last night. YOu made a good point. In defense of the internist's office, maybe our records got lost in the shuffle when they moved to a more computer-based system, but I remember from my growing up years that the dermatologist's office in which my mother worked had records of patietns that appeared to be many years old. In any case, I think that retailer based clinics may also be able to provide good preventive care. That simply was not the question asked by the researchhers for the present study.