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In the past 6 years, retail clinics have experienced nearly exponential growth nationwide. Capable of administering vaccines, performing some basic screenings (including for diabetes), and treating around 30 minor illnesses, these clinics are designed to provide stopgap medical care to consumers in the places where they regularly shop, such as strip malls and at drug, grocery, and discount stores.
Some experts doubt whether instore retail clinics, often staffed by a combination of nurse practitioners and physician assistants, can provide the medical care that many people truly need, particularly when diagnosing and treating diabetes.
"Diabetes care is best delivered in a practice setting where the patient is seen regularly over time," says Nathaniel Clark, MD, MS, RD, vice president for clinical affairs for the American Diabetes Association (ADA). "The key to successful diabetes management is keeping track of all the various elements needed: lab tests, eye exams, foot exams, flu shots, and smoking advice. The results of all these tests must be organized to promote action being taken as required."
Since 2000, when Cub Foods and QuickMedx opened the first store-based health clinic in St. Paul, Minn., the growth of retail clinics indicates that their affordability and convenience have attracted greater numbers of patients.
Most are open 7 days a week and generally do not require an appointment. Cost of services, ranging from about $30 to $100, is often less than that at doctors' offices. Insurance acceptance varies. Thus, even if patients have a regular physician, the low cost and ease of use might draw them to a retail clinic.
According to a report by the California HealthCare Foundation, the number of retail clinics in the United States may grow from <100 today to several thousand by the end of 2007 (see "FYI"). Take Care Health Systems, based in Conshohocken, Pa., runs 16 clinics in Kansas, Missouri, and Oregon and plans to open 1,300 more locations by 2007. Minneapolis-based MinuteClinic, which now operates 86 clinics, may have as many as 600 by 2009.
"Their survival isn't dependent on successfully competing with physicians. It's coffee shops, banks, even vending machines—whatever is the most profitable use per square foot for the retailer," says Mark Smith, MD, president and CEO of the California HealthCare Foundation.
Organized medicine, on the other hand, may perceive a threat to the turf traditionally held by physicians' practices. A report presented during the June 2006 Annual Meeting of the American Medical Association (AMA) House of Delegates shows that services at well-capitalized store-based health clinics often cost less than services provided by physicians in office-based practices and that the average visit to a store-based clinic is 15 minutes. But retail clinics are not equipped to handle emergency cases, according to the AMA report.
Although there are no hard figures on the number of people with diabetes visiting retail clinics for diagnosis and relief from symptoms, going to such a clinic "would be the worst idea in the world for a [person with diabetes] looking for any kind of medical care," says Larry Fields, MD, president of the American Academy of Family Physicians (AAFP), which represents >94,000 physicians and medical students. "It's a complicated problem and there may only be minor symptoms at first, particularly if [one has] type 1 [diabetes]; there's no continuity of care and a limited scope," Fields says.
The team of providers that is so essential to diabetes care (and to management of obesity and cardiovascular disease) also is outside the scope of a typical retail clinic. The retail clinic model relies on low prices, quick turnover of patients, minimal staff, and proprietary software systems that manage certain diagnoses and information based on a short list of simple procedures, according to the California HealthCare Foundation report.
"My concern regarding these retail clinics is that they are not connected to the regular care of the patient by the primary care provider or the endocrinologist," Clark says. "This disconnected care can lead to tests being duplicated or missed."
The AMA recommends that retail health clinics "establish protocols" for continuity of care by regular local physicians. This is just one of eight guidelines proposed; others include having store-based clinics use standardized medical protocols, offer clear definitions of their services, establish a referral system if the condition or symptom is beyond the clinic's ability to treat, give their practitioners "access to and supervision by" physicians, inform patients about the qualifications of their practitioners, establish sanitation and hygienic guidelines, and use electronic health records.
The AAFP now encourages physicians to provide more convenience for patients and to introduce measures that will curb costs—two features that are driving patients toward retail clinics.
Footnotes
"Health Care in the Express Lane: The Emergence of Retail Clinics," a report by the California HealthCare Foundation, is available at www.chcf.org/topics/view.cfm?itemiD=123218.
The American Medical Association's Council on Medical Service report, "Store-Based Health Clinics," is available at www.ama-assn.org/ama/pub/category/16456.html.
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