Retail Clinics Do Not Lessen Use of EDs, Study Shows

Megan Brooks

November 14, 2016

Contrary to expectations, the opening of retail medical clinics near emergency departments (EDs) has not led to fewer ED visits for common low-acuity conditions, according to a new study from the RAND Corporation.

"With increased patient demand resulting from the expansion of health insurance coverage, retail clinics may emerge as an important care location, but to date, they have not been associated with a meaningful reduction in low-acuity ED visits," the authors state in an article published online November 14 in Annals of Emergency Medicine.

"One hope for retail clinics was that they might divert patients from making expensive visits to the emergency department for minor conditions, such as bronchitis or urinary tract infections. But we found no evidence that this has been happening," lead author and RAND policy researcher Grant Martsolf, PhD, MPH, added in a news release.

Hopes Dashed?

First appearing in 2000, there are now nearly 2000 retail clinics across the United States. They receive more than 6 million patient visits annually. Retail clinics are conveniently located in supermarkets, pharmacies, and large chain stores. They are typically staffed by nurse practitioners, do not require an appointment, and accept most types of private insurance and Medicare.

The study included 2053 EDs in 23 states and covered the period from 2007 to 2012. The RAND team assessed how ED visits for 11 low-acuity conditions changed after nearby retail clinics opened their doors. These conditions were allergic rhinitis, bronchitis, conjunctivitis, other eye conditions, influenza, otitis externa, otitis media, pharyngitis, upper respiratory infections/sinusitis, urinary tract infections, and viral infections.

The researchers found that an increase in the number of retail clinics did not translate to fewer ED visits for these conditions (rate ratio = 0.999; 95% confidence interval [CI], 0.997 - 1.001).

However, greater retail clinic density did correlate with a small reduction in the subset of low-acuity visits among the privately insured (RR = 0.997; 95% CI, 0.994 - 0.999).

But according to the authors, even when patient access to retail clinics increased substantially in areas served by EDs, the decrease in ED visits for low-acuity conditions among the privately insured was less than 1%.

"Retail clinics may emerge as an important location for medical care to meet increasing demand as more people become insured under the Affordable Care Act," coauthor Ateev Mehrotra MD, MPH, of Harvard Medical School in Boston, Massachusetts, and adjunct researcher at the RAND Corporation, said in the release. "But contrary to our expectations, we found retail clinics do not appear to be leading to meaningful reductions in low-urgency visits to hospital emergency departments."

This study "challenges the notion that convenience settings substitute ED visits," writes Jesse M. Pines, MD, of the Center for Healthcare Innovation and Policy Research, George Washington University, Washington, DC, in a linked editorial.

"In actuality, the predominant effect is 'new use,' meaning that visits to convenience settings are mostly additive, rather than substitutive. Specifically, many people who would not have otherwise received treatment seek care in convenience settings because they're accessible and available," Dr Pines says.

She asks, "Given that convenience settings don't prevent ED visits, what can be done in an era in which looming government reforms may soon restrict the very payments that support them? The answer is not to build more convenience settings but to improve the value of existing settings by increasing the connectivity among providers and with longitudinal care. When people get sick and injured, there should be a system rather than the piecemeal network we have today in which each player is selling its own 'service,' " Dr Pines concludes.

The study was supported by the Agency for Healthcare Research and Quality. The authors have disclosed no relevant financial relationships.

Ann Emerg Med. Published online November 14, 2016. Full text, Editorial

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