People who visit retail clinics for acute care may be less likely to see a primary care physician later on, according to a new study examining the care habits of privately insured Americans who visit retail clinics.
Usually run by nurse practitioners and unaffiliated with health systems, retail clinics are expected to continue popping up, with as many as 3,200 open in the U.S. by 2014, according to one Deloitte estimate. They have led some doctors to fear that primary care will become even more fragmented.
“There is concern whether retail clinics may disrupt the relationship between patients and their personal physicians, which may make it difficult to maintain the quality and continuity of medical care,” said Dr. Ateev Mehrotra, an associate professor at the University of Pittsburgh School of Medicine and the study’s lead author, in a prepared statement.
The study, published in the Journal of General Internal Medicine, was conducted by Mehrotra and other researchers from University of Pittsburgh School of Medicine, research firm RAND Corp. and Carnegie Melon University. They used insurance claims from Aetna filed between 2007 and 2009 — a period when retail clinic visits increased ten-fold — to identify patients who visited a primary care physician or a retail clinic for a simple acute condition in 2008. The researchers looked at patients’ continuity of care and their likeliness to seek preventive care in the one year after that initial visit.
People who initially visited a retail clinic made fewer subsequent visits to a primary care physician for conditions that were treatable by a retail clinic. They were even less likely to have two or more visits with the same PCP. However, there was no difference between the two groups in rates of preventive health examinations like breast cancer screening or diabetes management.
“Some might contend that continuity is the cornerstone of primary care and, therefore, retail clinics’ negative impact on continuity is critical,” the authors wrote in the study. “Others might argue that continuity and first-contact care are less important than preventive care, especially for a health patient population. In this light, retail clinics’ impact on primary care may not be as great as feared.”
One thing worth noting, though, is that previous research from Mehrotra’s group found that retail clinics seemed to be serving a patient population that is underserved by primary care physicians.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
We need more information on how these clinics affect actual health outcomes, the researchers concluded, and about how they are used by publicly insured and uninsured patients before we can judge how primary care is really affected.
