Convenient Clinics

Image: Eric E Castro (Creative Commons / Flickr)

The landscape of the health system in the United States is changing to offer patients improved access to care beyond the traditional doctor’s office or emergency room visit. The advancing popularity of retail clinics provides patients a choice when the need for immediate care arises. Retail clinics offer a more convenient alternative for primary care with locations in “big box” stores such as Target and Walmart, access seven days a week, hours that extend beyond those of traditional primary care offices, and partnering with integrated care organizations such as the Cleveland Clinic and Allina Health.

The number of retail clinics in the United States increased between 2007 and 2010 from 300 to approximately 1,200; utilization increased 102 percent annually from 2007 to a 2009 total of 5.97 million visits annually. As the retail clinic model grows, these health centers are looking to expand their services. In 2010, a number of retail clinics began to provide chronic illness services for conditions such as asthma, hypertension, and diabetes. Expanded use and the broadening scope of practice for retail clinics has prompted research to determine the characteristics of patients who attend these clinics and types of conditions for which they are seen.

This retrospective observational study examined the trends in the use of retail clinics as well as the sociodemographic characteristics of their patients. The population of interest were patients who received care from Minute Clinic, TakeCare, or LittleClinic between 2007 and 2009. Health records and clinic operators were consulted to record patient information including sociodemographic data, whether individuals had a primary care physician, payment method for each visit, and the diagnostic code or reason for the visit. Results were analyzed and compared to those of an earlier study of retail clinic use between 2000 and 2006.

The characteristics of those who received care at retail clinics between 2007 and 2009 were primarily female (62 percent), aged between 18 and 44, had health insurance, and did not have a primary care provider. The leading reason for retail clinic visits was acute care for conditions such as upper respiratory tract infections or pharyngitis. The second most common reason was preventive care – vaccinations.

Roughly 44 percent of retail clinic exams took place outside of typical physician office hours. Compared to data from 2000-2006, retail clinic visits by children under the age of eighteen shrank slightly, while those of patients over the age of sixty-five nearly doubled from 7.5 percent to 14.7 percent. Visits for preventive care increased dramatically from 21.8 percent in 2000-2006 to 47.5 percent in 2007-2009, with vaccines accounting for the majority of the increase (19.7 percent versus 40.8 percent). While preventive care visits increased, acute care visits decreased from 78.2 percent to 51.4 percent over time.

Commentary

It seems clear that retail clinic growth stems from delivering a product that offers more convenience through after-hours accessibility, shorter wait times, predictable costs, and locations within “big box” stores and retail pharmacies that many patients frequent anyway. The healthcare system is trending away from traditional modes of care. Independent surgical centers are breaking away from hospitals to offer less complex, same day procedures; urgent care clinics remove some of the acute burden from emergency rooms; and retail clinics seem to have found a specialized niche in less serious acute and preventive care. The undertone of the increased utilization of retail clinics is patient satisfaction. With no clear difference in quality of care, patients will opt for a clinic that provides quick, affordable care in a convenient location.

As retail clinics grow and expand, they face some challenges. The first challenge will be to continue growing their market share in constructive ways and gain the trust of patients in an environment where quality is strongly emphasized. This becomes even more challenging as e-health becomes a more convenient extension of the traditional primary care setting. Secondly, if their scope of practice expands to include chronic care management, these clinics will begin to deal with more complex patients retail clinics currently are not equipped to handle or will require time and resources beyond what a successful business model allows. Patients may become overwhelmed by choices between overlapping services and frustrated by excessive referrals to more capable providers.

Challenges aside, retail clinics have proven to be a viable supplement to traditional primary care and hold tremendous potential to ease the burden on primary care providers, provide cost savings to patients and the overall health system, and improve patient satisfaction by improving the convenience of care.

by Patrick Fitzgerald, MPH