Walk-in clinics good choice for minor ills
Posted by medconsumers on September 29, 2009
Big chain stores like Wal-Mart and CVS have opened on-site medical clinics for customers seeking care for minor problems like sore throats. Though these retail clinics have been targets of disapproval from medical organizations, a Rand Corp. study showed that the quality of the care they provide is comparable to and less expensive than the care provided at physician offices and urgent care centers. The study was led by Ateev Mehrotra, MD, University of Pittsburgh, and published this month in Annals of Internal Medicine.
Store-based walk-in clinics have become popular for a variety of reasons. No appointments are required; they are open seven days a week and some evenings; less time is usually spent in the waiting room; and an increasing number of Americans do not have a primary care physician. Many of these clinics are manned by nurse practitioners or physician assistants, which raises the possibility of inferior care in the minds of some people, primarily physicians. The most high-profile criticism, however, came from the AMA, which saw a potential conflict of interest in retail clinics where health workers may be overprescribing drugs sold in their stores. (It’s hard to keep a straight face about this complaint from the AMA, not known to have the same concerns about surgeons recommending surgery.)
The Rand Corp. study is based on information from the claims made by 2,100 enrollees in a large Minnesota health plan that has allowed its enrollees to use retail clinics for the last five years. Dr. Mehrotra and colleagues looked at the claims made for three common illnesses—sore throat, urinary tract infection and ear infection. The claims for these three illnesses treated at retail clinics were compared with claims for the same illnesses treated at physician offices, urgent care centers, and emergency rooms (ERs).
The prescription drug costs were the same at retail clinics, physician offices, and urgent care centers. The exception was the ER where the average prescription costs were higher and the quality of care was significantly lower than in the other three settings. The overall cost of the visit to a walk-in retail clinic was $110, compared to $166 for physician offices, $156 for urgent care centers, and $570 for the ERs.
A related study published in the same issue of Annals of Internal Medicine explored the general question of whether these clinics provide access to care for “underserved populations.” Using data from the U.S. Census and 2008 Health Resources and Services Administration, the study found that retail clinics are currently located in more advantaged neighborhoods and concluded that this makes the clinics inaccessible to those most in need.
Both studies were funded by California HealthCare Foundation.
Maryann Napoli, Center for Medical Consumers©