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Health, Science, Environment

Store-based health clinics

This article first appeared in the St. Louis Beacon: Some retailer health clinics showing signs of decline while others flourish

The recent surge in walk-in health clinics at pharmacies, supermarkets and other retailers is showing signs of slowing. Yet many are surviving and even thriving.

While the number of all store-based clinics has grown from 125 to 963 nationwide over the past three years, 69 clinics in 15 states have recently closed their doors, according to a story in the Wall Street Journal this month. Many believe the expectations for growth were simply too high with investors anticipating a break-even point in as few as six months, while a more realistic target appears to be 18 months to two years.

On the flip side, Lauren Tierney, director of communications for TakeCare Health Services, says their clinics are growing at a rapid clip with 160 TakeCare clinics nationwide across 14 states and 17 markets and many more on the horizon. According to the Wall Street Journal article, Walgreen's TakeCare clinics are expected to expand by some 240 locations by the end of this year. Tierney reports that the St. Louis market is particularly strong with 14 TakeCare clinics opening since 2006. All are primarily staffed by nurse practitioners and overseen by local, board certified physicians.

"We are continuously expanding and we believe firmly in our mission of revolutionizing health care and providing additional access points for high quality and convenient healthcare," Tierney said.

Profile of an In-Store Health Clinic

Over the past few years, hundreds of clinics have sprouted in such recognizable storefronts as Walgreen's, Wal-Mart, CVS and Schnucks. The clinics are most often staffed by "mid-level providers," nurse practitioners or physician assistants who are trained in treating a limited range of health conditions. They are able to prescribe basic medications but typically do so under the supervision of a physician.

These clinics are designed to fill a niche in a health care shortage environment. The idea is that patients can get quick and relatively simple treatment rather than waiting days or weeks to be seen by a primary care physician, or perhaps not being seen or treated at all.

Sue Ferbet, the lead nurse practitioner for the St. Louis TakeCare clinics, gives this perspective: "I came from a very busy internal medicine practice. One thing that I found frustrating was the length of time it took to be seen."

Located in drugstores, grocery stores and big-box retailers, these clinics set out to treat only "simple" health issues such as sore throats and sinus infections. They typically function as fee-for-service, with set payments, and don't require appointments. The price for a visit is usually less than $100 and many also accept insurance.

The AMA Perspective

In June of 2006, the American Medical Association (AMA) adopted a set of nine principles to help ensure these store-based health clinics were providing patients with appropriate and optimal care. The guidelines came in response to growing public and professional concern about the safety and reliability of these clinics.

Many physicians and experts believe the clinics carry an inherent risk of fragmentation of patient care. This includes inadequate follow-up and missed opportunities for preventive care, particularly if such clinics are substituted for a "medical home" where regular health care is received and patients are known by their physicians.

The AMA states that store based clinics must:

  • Have a well-defined and limited scope of clinical services, consistent with state scope of practice laws.
  • Use standardized medical protocols derived from evidence-based practice guidelines to insure patient safety and quality of care.
  • Establish arrangements by which their health care practitioners have direct access to and supervision by those with medical degrees (MD and DO) as consistent with state laws.
  • Establish protocols for ensuring continuity of care with practicing physicians within the local community.
  • Establish a referral system with physician practices or other facilities for appropriate treatment if the patient's conditions or symptoms are beyond the scope of services provided by the clinic.
  • Clearly inform patients in advance of the qualifications of the health care practitioners who are providing care, as well as any limitation in the types of illnesses that can be diagnosed and treated.
  • Establish appropriate sanitation and hygienic guidelines and facilities to insure the safety of patients.

In addition, the AMA says clinics should be encouraged to use electronic health records as a means of communicating patient information and facilitating continuity of care. In turn, the clinics should be encouraging patients to establish a relationship with a primary care physician to to ensure continuity of care.
Some have already taken these principles to heart.

"One of the biggest things we offer is entrance into the system," Ferbet said. "We get (patients) hooked up with a primary care physician if they don't already have one, as well as take care of their immediate need.

For information

Health Clinics Inside Stores Likely to Slow Their Growth | Wall Street Journal

AMA adopts measures to promote quality and safety at store-based health clinics | AMA

Dr. Cindy Haines is managing editor of Healthday-Physician's Briefing and president of Haines Medical Communications, Inc., a full service medical communications and consulting firm. As a board-certified family physician, Haines is well-versed in all areas of health care, with particular interest in fitness, nutrition, and psychological health.

Her weekly column on health care issues will appear here each Friday, and you can listen to Dr. Haines' House Call on KTRS.

Cynthia Haines special to the Beacon

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