Retail Medical Clinics Offer Quality Care: Study

Walk-in retail clinics staffed by nurse practitioners provide high-quality care for routine illnesses, a new study has found. Writing in the Sept. 1 issue of the Annals of Internal Medicine, study author Dr. Ateev Mehrotra said that retail clinics -- which are typically staffed by nurse practitioners and found in drug stores and other retail chain stores such as Target and Wal-Mart -- provide a good standard of care for sore throat, ear infections and urinary tract infections. Mehrotra is an assistant professor at the University of Pittsburgh School of Medicine and a policy analyst at Rand Health. "I'm interested in how we deliver new forms of health care," said Mehrotra, who compared data from retail clinics, doctors' offices, urgent care centers and hospital emergency departments. "There's been a lot of discussion about the quality and effectiveness of these clinics; I wanted to find out more. From the patients' perspective, their appeal is twofold. They're convenient and they provide significant cost savings." Retail clinics have become increasingly widespread in recent years. One such operation is CVS's MinuteClinic, the focus of Mehrotra's research. MinuteClinic staffers treat minor illnesses and injuries, and provide vaccinations and various health and wellness services. Customers can walk in without an appointment, and the clinics are open seven days a week. Most visits take no more than 15 minutes, and costs vary from $30 to $110, according to the MinuteClinic Web site. According to Mehrotra, one-third of Americans live within a 10-minute drive of a retail clinic, and more than 6,000 of these clinics are expected to open across the United States within five years. Surveys of patients who received care at retails clinics have been positive, he added. Mehrotra's research team analyzed information contained in insurance claims of 2,100 Minnesotans between 2005 and 2006. The study authors chose the three diagnoses because they made up a combined 40 percent of the clinics' caseload. Using various statistical tools, the researchers found that the standards of care in retail clinics in Minnesota were consistent with accepted medical guidelines for those ailments, including the frequency and type of lab tests performed and drugs prescribed. Treatment costs at the retail clinics were 30 percent to 40 percent lower than in physicians' offices and urgent care centers, and 80 percent lower than in emergency rooms. The researchers did not detect any significant misdiagnoses, Mehrotra said. "The increasing number of patients who receive care at retail clinics has fueled concerns about increased health care costs, greater rates of misdiagnosis, overuse of antibiotics, and decreased delivery of preventive care," Mehrotra and colleagues wrote in the study. "When we compared these aspects of care in retail clinics, physician offices, urgent care centers, and emergency departments, we found little evidence to support these concerns." Dr. Scott D. Hayworth, chief executive officer of Mount Kisco Medical Group in New York, one of the largest medical practices in the Northeast, remains unconvinced and is no fan of the retail clinic model. For one, physicians provide more comprehensive and expert care, and they know their patients' medical history, he said. "These [clinics] are clearly picking a few minor ailments, which tend to be less expensive to treat," said Hayworth, who has about 200 physicians on staff as well as nurse practitioners and physician assistants. "When you have more serious illnesses, you need more back-up," which drives up costs, he added. Nurse practitioners and physician assistants (PAs) are effective in traditional medical settings, where there are always supervising doctors, Hayworth said. But in a retail clinic, there is no supervising doctor present, he said, adding, "Say a sore throat turns out to be something more serious. A PA may miss that diagnosis." Mehrotra acknowledged that his study had several limitations. It was based entirely on data from one state. It looked at predominantly young, female, insured patients who were relatively healthy and affluent. And it focused on only three diagnoses. Still, Mehrotra said, his study provides evidence that retail clinics can offer a safe level of care and have a place in the health-care system.