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Retail medical clinics attracting more seniors

Wednesday August 22, 2012
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Fast-growing retail medical clinics these days attract more older patients and deliver more preventive care, especially flu shots and other vaccinations, according to a study.

Researchers with the RAND Corporation found that visits to retail medical clinics increased fourfold from 2007 to 2009, with the proportion of patients older than 65 growing from 8% to 19% of all visits during this period.

More than 44% of visits to the clinics occurred on the weekend or other hours when physician offices typically are closed, suggesting retail clinics fill a need for convenient care, according to the study, which was published Aug. 15 on the website of Health Affairs.

"Retail medical clinics continue to grow rapidly and attract new segments of users," Ateev Mehrotra, MD, MPH, an associate professor at the University of Pittsburgh School of Medicine and a researcher at RAND, said in a news release. "They remain just a small part of ourpatient medical care, but appear to have tapped into patients’ needs."

Whether demand for the clinics will continue to grow with implementation of the Affordable Care Act is unclear.

"If demand for primary medical care drives longer wait times to see a doctor as it has following healthcare reform in Massachusetts, then this could drive greater demand for convenient alternatives such as retail clinics," Mehrotra said.

The study is the latest in a series of reports from RAND Health that has documented the rapid growth of retail medical clinics, which are located in drug stores or other retail businesses. The clinics typically are staffed by nurse practitioners and offer basic types of healthcare at clearly posted prices.

Physician groups have expressed concern that retail clinics could disrupt patients’ relationships with their primary care physicians and interrupt continuity of care, according to the news release. The criticism has increased since some clinic operators began offering care for chronic illnesses such as diabetes, asthma and hypertension.

Researchers examined the latest trends in the use of retail medical clinics by analyzing information from 2007 through 2009 obtained from the three largest retail clinic operators — MinuteClinic, TakeCare and LittleClinic — which account for 81% of the clinics operated nationally. Trends in usage were compared to earlier findings from 2000 to 2006.

Visits to retail clinics reached 5.97 million in 2009, up from 1.48 million in 2007. But retail clinics still account for only a small slice of outpatient medical care when compared to the estimated 117 million ED visits and 577 million visits to physicians’ offices made each year.

Visits to retail medical clinics for vaccinations increased sharply from 2007 to 2009, researchers found. Another recent study published by RAND researchers found that vaccination visits to the three major retail clinic chains quadrupled to more than 1.9 million in 2009. Most of the inoculations were for influenza.

"The number of vaccinations provided at retail clinics could grow even larger if providers started counseling patients about the need for inoculations when they visit the clinics for other care," said Lori Ucher-Pines, an associate policy researcher at RAND.

In the latest study, the researchers found that the proportion of retail clinics visits made for acute medical problems dropped from 78% to 51%. There was a corresponding increase in visits for preventive care, making up more than 47% of visits by 2009. The study does not capture the impact of a push made by retail medical clinic operators beginning in 2010 to increase the services offered for chronic illnesses.

The proportion of patients who reported not having a primary care physician remained at more than 60%, even though researchers had expected the number to drop as use of the clinics increased. They said patients with no relationship or a "weak" relationship with a primary care physician may be more likely to seek care at a retail clinic than patients with a strong relationship with a physician.

To read the study, visit http://content.healthaffairs.org/content/early/2012/08/14/hlthaff.2011.1128.full.


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