It is 7:00 p.m. on a weeknight as I walk into my local pharmacy. I sign in at a kiosk to get my annual flu shot. Waiting for the nurse practitioner to call my name prompts me to think about how convenient it is to take care of this in 20 minutes — less than the time it takes to drive to my doctor’s office, let alone sit in her waiting room or wait the week it might take to get an appointment.
On the surface, the emergence of so-called “retail medicine” fills a niche. In reality, the concept may be more controversial. Furthermore, I ponder what the future holds for these unique providers of health care, especially as the Affordable Care Act becomes a reality.
The first retail clinic opened in Minnesota in 2000, and now more than 1,200 pepper the landscape, mainly in retail stores such as chain pharmacies. Retail clinics treat a limited menu of acute conditions, such as sore throats and minor skin problems, in addition to offering preventive services including cholesterol screenings and vaccinations. Staffed primarily by nurse practitioners and physician assistants, these venues achieve a high level of patient satisfaction, most likely attributable to their convenience and low cost.
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Some see retail clinics as a threat to the financial viability of private practices, and to the continuity and quality of care that private practices offer. The opposing view is that retail clinics may take the strain off of overwhelmed physicians, and that traditional health-care settings still serve as resources when follow-ups and referrals are needed.
Although concerns about the quality of the care rendered by retail clinics — as would be evidenced by such indicators as the need for repeat visits, the overprescribing of antibiotics and missed opportunities for preventive care — have not come to fruition, physicians and their professional societies continue to harbor worries regarding fragmentation of care, coordination of electronic medical records (EMRs), and the lack of formal oversight.
Not surprisingly, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) have issued statements speaking out against retail clinics, whereas the American Association of Nurse Practitioners has endorsed these setups.
The AAP and AAFP have raised concerns about loss of the medical home and continuity of care, particularly for chronically ill patients. The AANP points to the provision of high-quality, timely, evidence-based care being made available to those who might not otherwise be able to see a health-care practitioner. All organizations, including the American Medical Association, have made recommendations to assure that care is collaborative with a physician and is carefully monitored.
Retail clinics may branch out into chronic-disease management or weight loss or smoking cessation counseling, and make services available in the workplace or through telemedicine. However, it must be made clear that there are limitations to the types of patients and illnesses that can be adequately and appropriately triaged to such venues. Collaboration with and referral to traditional primary-care settings will only strengthen, not hamper, the relationship between retail clinics and conventional medical practices as we struggle to provide primary-care services to all who require them.
As I wait to be called in for my flu vaccine, how can I deny that there is a place for retail clinics?
Judi Greif, RN, MS, APN-C, is a family nurse practitioner currently residing in East Brunswick, N.J.
