Retail Clinics Not Equitably Distributed

Image: Eryn Hatzithomas (Creative Commons / Flickr)

The authors of this study examined 930 retail clinics across the nation in order to plot their geographic location according to United States Census tracts. Eighteen states had no retail clinics and 17 had greater than 25 clinics. Florida, California, Texas, Illinois, and Georgia had the highest numbers of clinics. To compare the distribution of retail clinics versus chain stores (e.g. Walgreens, CVS, Wal-mart, HEB, etc.) researchers examined the 6 counties with the greatest number of retail clinics. The following counties were sampled: Cook County, Illinois; Harris County, Texas; Los Angeles County, California;  Orange County, California; Palm Beach County, Florida; San Diego County, California. Estimates were that these six counties provided sufficient power (90%) to detect a 10% difference in the location of retail clinics in medically under-served communities.

In general, chain stores tended to be located in more advantaged census tracts. Trends indicated that stores with clinics tended to be more prominent in areas with more white residents (p<0.001), fewer blacks (p<0.01) or Hispanics (p<0.001), more children (p=0.03), higher home ownership (non-significant in multivariate analysis), and higher income (p=0.002).  The median income in areas where stores with retail clinics located was significantly higher ($59,884) than areas without clinics ($50,893).

In regards to the primary outcome of this study, retail clinics were far less likely to be located in medically under-served areas; 16% of census tracts with clinics were located in medically under-served areas versus 32% of census tracts without clinics were in medically under-served areas (OR=0.49, p=0.008).

Commentary:

As with may other market-driven aspects of life, such as grocery stores, movie theaters, etc, retail clinics are more often located in areas of higher income. Although this study does provide some convincing evidence that retail clinics are perpetuating racial, ethnic, and income disparities in health, the generalizability of this inference is limited to urban areas where large numbers of retail clinics exist. If such retail clinics are truly going to live up to their goals of providing an entry point for patients without primary care and those living in under-served communities, significantly more effort must be given to equitably locating clinics in medically under-served, low-income, and minority areas.

by

Cedric K. Dark, MD, MPH