February 24, 2014
News Review From Harvard Medical School -- Doctor Group Opposes Retail Clinics for Kids
Clinics in grocery and drug stores are not the best places for kids to get primary medical care, a group of children's doctors says. The statement is an update of the American Academy of Pediatrics (AAP) policy on retail-based clinics. Several national chains have these clinics in their stores. They usually are staffed by physician assistants or nurse practitioners, not doctors. The AAP says that care from retail clinics is fragmented. Kids may see a different person each time. The clinics don't have a child's medical records. They don't provide follow-up care. Parents can't call them after hours. The statement mostly is the same as the AAP's policy released in 2006. But it also urges retail clinics to support a patient's "medical home." This is the doctor's office or clinic where the child receives care on a long-term basis. For example, the policy says retail clinics should share information about all visits with a patient's medical home as soon as possible. Spokesmen for CVS and Walgreens drug store chains told Reuters Health news service that they strongly support the medical home model. They said their clinics do coordinate with patients' medical homes. The journal Pediatrics published the statement February 24.
By Henry H. Bernstein, D.O.
Harvard Medical School
What Is the Doctor's Reaction?
Ever notice a health clinic inside your local drugstore, supermarket or department store? This so-called retail-based clinic provides limited care, especially for children. Doctors usually do not see the patients there. A physician assistant or a nurse practitioner usually does. These providers follow special rules and guidelines in treating patients for specific types of problems.
Retail clinics are becoming popular for several reasons:
- They are easy to get to in your local community.
- No appointment is needed.
- Wait times are often short.
- They can be cheaper than going to the doctor's office or emergency room.
More than 6,000 retail-based clinics have opened around the country since 2000. Most people who go to these clinics are adults. About 15% of children use them, too.
The American Academy of Pediatrics (AAP) just updated and published a policy statement on these retail-based clinics in the journal Pediatrics. The AAP says that:
1. Children should not receive their primary care at a retail-based clinic because providers at these clinics:
- Fragment care.
- May not offer the same high quality care as doctors.
- Are not always trained in pediatric medicine.
- Do not have access to the child's medical record during the visit. This means they do not know the child's past health well.
- See patients with "minor" problems that could be more serious than they think.
- Are not available if the child needs to be seen after hours or if the family has more questions.
- Do not generally follow up with the patient and family once they leave the clinic.
- Do not see patients over many years. This is especially important for children with special needs or long-term medical problems.
- May not be able to prevent germs from spreading in an open space (such as a drugstore).
2. Health insurance companies should not offer lower copays or other cost advantages for patients who go to a retail clinic instead of their regular doctors.
3. All retail-based clinics should support the concept of a "medical home" for children. This includes:
- Forming a close relationship with the patient's medical home, whenever possible
- Sharing patient information with the medical home right after the retail clinic visit
- Referring patients back to their medical homes
- Helping patients find a medical home, if they do not have one
- Arranging for after-hours care
What Changes Can I Make Now?
All children should have a medical home. It can be in a doctor's office, hospital clinic, community health center or school-based clinic. Emergency rooms are not medical homes. They are for emergencies, when your child has a serious sickness or injury that cannot wait for a trip to the doctor's office.
A medical home is much more than an actual building with doctors. A medical home means that your pediatric team:
- Has a trusting relationship with you and your child
- Knows your child's health history
- Listens to your family's worries and needs
- Cares for your child over years, as he or she gets older
- Develops a care plan with you and your child
- Meets the medical and non-medical needs of your child and family
- Gives advice on breastfeeding, vaccines, growth, development, diet, safety, parenting and more
- Respects your family's culture and traditions
- Connects you with specialized doctors, when needed
- Knows of programs in the community that may help meet your family's needs
- Is always available to help with sudden sickness (all day, all week, all year)
You can take steps to make the most of your medical home visits:
- Write down and ask all questions you have.
- Talk about your worries.
- Let the doctor know what is most important to you and your child.
- Check the next steps in your child's care plan.
- Ask about community programs that may help your family.
If a retail-based clinic is the only choice, make sure the clinic will share information about the visit with your medical home. Try to avoid going to a clinic just for shots or sports physicals. The medical home knows your child best and needs to keep all of his or her health information up to date. Doctors also use office visits to give advice and talk about other issues or concerns.
What Can I Expect Looking to the Future?
I hope that more and more parents will identify a medical home for their children. You can expect coordinated, high-quality care to be the top priority in your child's medical home. The medical home will provide continuing care over many years, have 24/7 care available and help your child to reach the best possible health outcomes. Although more retail clinics are around these days and they may seem popular, they just do not provide the best primary care for children.