Retail Clinics Siphon Patients From Physician Practices

Lara C. Pullen, PhD

November 02, 2012

Retail clinics may disrupt continuity of care as well as influence whether or not a patient goes to a primary care physician (PCP) first for a new condition. However, they do not appear to have a negative effect on diabetes management or preventive care, according to a new study.

Rachel O. Reid, MS, from the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues present results from their retrospective cohort analysis in an article published online October 16 in the Journal of General Internal Medicine. The researchers analyzed health plan claims from 2007 to 2009 and compared the care received by patients who visited a PCP with the care received by patients who visited a retail clinic.

The authors focused on the short-term (12-month) effect of retail clinics, defining an index visit as a visit for a simple acute condition that occurred in 2008.

They found that patients who visited retail clinics were likely to return to retail clinics for subsequent acute problems. These patients were also less likely to return to a PCP for a new simple acute condition, with a 27.7 visit per 100 patients differential reduction (P < .001).

In addition, the reason for index visits appeared to differ between retail clinics and PCPs: Visits to the PCP appeared to be more complex than visits to retail clinics.

One of the limits of the study is that the authors did not distinguish between informational continuity of care and visit continuity of care. The authors were also not able to assess what was written in the medical chart, and therefore could not evaluate preventive services, counseling, or disease management services that would have only been noted in the chart.

"Taken together, the interpretation of our findings depends on one's view on the relative importance of different aspects of primary care," the authors write. "Some might contend that continuity is the cornerstone of primary care and, therefore, retail clinics' negative impact on continuity is critical. Others might argue that continuity and first-contact care are less important than preventive care, especially for a healthy patient population."

The authors also note that at the time of the study, retail clinics did not offer preventive care services.

Tine Hansen-Turton, MGA, JD, NNCC, CCA, PHMC, PSIJ, executive director, Convenient Care Association, Philadelphia, Pennsylvania, reviewed the article and told Medscape Medical News via email: "The study, which is based on older data, when the clinics were generally in their infancy, showed that patients who visit retail clinics are no less likely to undergo preventative or screening tests administered by PCPs, and there was no evidence that clinic visits disrupted the physician–patient relationship. Also, clinics and PCPs have sought to maximize continuity of care since [these data were collected], through patient record sharing and other means, including the formation of partnerships between retail clinics and leading healthcare systems in many markets. This collaboration is important to the quality and cost-effectiveness of care, and both parties should continue their efforts to enhance it."

The authors have disclosed no relevant financial relationships. Hansen-Turton is the executive director of Convenient Care Association.

J Gen Intern Med. Published online October 16, 2012. Full text