In-store health clinics: a new approach to primary care?

Health clinics based in retail outlets, particularly drug stores, are changing the way primary care is delivered. Their proponents cite access, convenience, and price transparency as the major reasons for their popularity and growth. Further fueling this concept is the growing shortage of primary care doctors.

Staffed mainly by nurse practitioners, the clinics offer quick services for routine health conditions such as colds and sore throats that formerly would have taken patients to the office of a family physician or general internist.

The expansion of these clinics is nothing short of phenomenal. Their umbrella trade group, aptly titled the Convenient Care Association, estimates that there will be more than 700 of them by the end of this year, and some 2000 by the end of next year.

Initial concerns by medical associations that the clinics would be unregulated and provide mainly one-shot care other than continuity are largely dissipating.

For example, Minneapolis-based MinuteClinic – a subsidiary of CVS Caremark Corporation and the largest provider of retail-based healthcare in the US – now has full accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Its president, Michael Howe (pictured left), a former executive with Procter & Gamble, told HOC: “Our services complement primary care providers and our nurse practitioners make it a point to stress the importance of a regular medical exam with every patient they see.” He adds that “waiting times, compared with a doctor’s office, typically are about 15 minutes… and the average cost is about $60.”

The American Academy of Family Physicians (AAFP), rather than opposing the concept, has issued a set of standards for in-store clinics… and a former AAFP president serves on the company’s Clinical Quality Advisory Council.

A by-product of the clinics is that they have an impact on employee productivity because of the time saved in comparison with time spent in doctors’ waiting rooms.

In the United Kingdom, plans are in motion to formalise minor ailment clinics where pharmacists and nurse prescribers can serve to direct patients away from busy doctors’ offices.

The major UK pharmacist chain, Boots, is establishing walk-in clinics in concert with major supermarkets. However, such clinics have been slow to take off because they are limited by the National Health Service Primary Care Trusts’ budgets, since both doctors and pharmacists operating in these clinics will be seeking reimbursement for their prescribing.