Can a pharmacy be your only doctor?

You go to your local pharmacy chain to buy shampoo and you notice that the clinic in the store offers flu shots and you don’t have to wait. You’ve overdue that shot, so you’re doing it—and you’re accepting the clinician’s offer of a blood pressure screening.

You were done just 15 minutes after you walked in, satisfied that you had effortlessly received good care at little or no cost as the clinic accepts your insurance.

Is there a catch? May be. Will your PCP, with your entire medical history in front of you, interpret your blood pressure numbers differently than a nurse practitioner in a retail clinic? Did the clinic send your blood pressure data to your doctor? If you don’t have a primary care physician, should you accept the nurse practitioner’s casual remark that your blood pressure is “slightly elevated”?

For every service you receive at a retail clinic, these questions may arise.

But it’s undeniable that these clinics – usually in pharmacies, supermarkets, and other large stores – offer something that too many Americans lack: easy access to some basic, high-quality health care, often at a lower cost than hospitals. a traditional doctor’s office, an emergency room staffed by doctors, or an emergency room.

Will retail health care contribute to your long-term health?

Bottom line: If you’re thinking about getting healthcare at a retail clinic, it’s wise to think about how this way of delivering healthcare will serve you in the long run, not just how quickly you can get things off the hook.

“Now we have a plethora of treatment options,” says Dr. Ateev Mehrotra, a professor of health policy at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center in Boston. “Choice is good, but it creates new challenges — for example, patients have to triage themselves” to determine which healthcare facility is best suited to diagnose and treat their minor illness or injury.

“There is also a trade-off between cost, quality, and convenience, and navigating everything is difficult,” he adds.

Retail clinics can offer good prices for basic services

As a popular entry point, retail clinics have become a major force in American healthcare. CVS with over 1100 MinuteClinics treats sore throats, can remove stitches or surgical staples and so on. Walgreens has hundreds of clinics that can treat back pain, headaches, and urinary tract infections, among other conditions. But what value can consumers expect from a for-profit clinic without a doctor?

Researchers have found that you can usually find good care at a competitive price.

“For a select group of conditions, retail clinics provide the same quality of service as they would in other settings,” Rand Corp. said in a report. for 2016.

And researchers from Northeastern University reported in 2019 in the journal Medical Care that retail clinics charge less on average for similar services than other healthcare providers.

They are best suited for young people without chronic diseases.

Whether retail clinics are a good option for you depends, at least in part, on your age and general health.

“People who visit these clinics tend to be younger, healthier, and less likely to see a primary care physician,” says Dr. Mehrotra. “In terms of what we looked at in our study, such as urinary tract infections, tonsillitis, sinusitis, the treatment that this population receives in a retail clinic is equal to, and in some cases exceeds, what they could receive in polyclinic. emergency department or emergency center.”

But for older patients, especially those with multiple chronic conditions, “continued care is really important – knowing their medical history and medications,” Dr. Mehrotra says. “It might not be the best option for them.”

Most retail clinics do not provide comprehensive primary care

Physicians worry about the long-term effectiveness of medical care provided exclusively by mid-range retail providers such as nurse practitioners. According to the Rand report, only about a third of retail clinic users reported having a primary care physician.

Dr. Mehrotra’s research found that “going to retail clinics has a negative effect on continuity of care—going to the same doctor over and over again,” he says. “And many studies show that longer treatment is associated with better outcomes.”

Medical organizations agree. “Family physicians build long-term relationships with patients and have a holistic view of their health,” Rebecca Beeler, spokeswoman for the American Academy of Family Physicians, said in an email. “This gives our providers a unique opportunity to deliver proactive preventive care that prioritizes long-term patient well-being.”

“Unfortunately, in the US over the past 10 or 15 years, people have been less likely to seek primary health care,” says Dr. Mehrotra. “In our study, most patients told us, “I don’t have a doctor.” But it’s easier said than done for patients to get into the practice of primary health care.”

Indeed, more than 97 million Americans live in regions that lack primary health care workers, according to an analysis by KFF, a nonprofit health policy organization.

Medical centers expand the range of their services

Despite the shortage of clinicians, major players in the retail healthcare sector are starting to offer a wider range of medical services, partnering with health systems and even acquiring primary health care networks.

CVS, which has partnered with the Cleveland Clinic and added the HealthHUB brand to its 900 MinuteClinics, provides services such as chronic care for people with conditions like diabetes. In addition, Walgreens is partnering with VillageMD to open full-service, physician-staffed primary care locations with some of its pharmacies.

Patients face challenges integrating their medical records

Regardless of the type of retail clinic, it is important that patients ask how their health and care information will be shared between the clinic and other provider organizations. Even for a minority of health care systems that own or partner with retail clinics, tracking personal health data about patients over time is difficult, according to 46% of health care executives and physicians surveyed in 2022 by the Massachusetts Medical Society’s NEJM Catalyst.

“Ideally, you want to have all your medical records in one place,” says Kenneth Hertz, principal consultant for KTHConsulting, a practice management consulting firm. “Because your records are scattered in different places, it is difficult to get complete information.”

Hertz and his wife faced fragmentation of their medical records.

“At our local clinic, which is staffed by paramedics and nurse practitioners, they have medical records for me and my wife, but they don’t send the information to our primary care physician,” Hertz says. “But my wife is the kind of person who will always get printouts and bring them to our doctor’s office so they can scan them. It serves as its own health communications network. Thus, the integration of records is clearly problematic.”

It is unlikely that retail clinics will resolve issues of continuity of care and medical records anytime soon. But for the millions of Americans who prioritize convenience or have limited access to healthcare professionals, a nurse practitioner at the back of the store can help fill some important care gaps.

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