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For kids, retail medical clinics not best choice: pediatricians

By Kathryn Doyle

NEW YORK (Reuters Health) - In an updated policy statement, the American Academy of Pediatrics (AAP) still says kids shouldn't get their primary care from clinics at retail outlets. But it acknowledges that the clinics have become more popular and many people choose them anyway.

Retail medical clinics, first opened in the U.S. in 2000, have popped up in grocery stores, drug store chains and "big box" stores. There were more than 6,000 such locations in the country as of 2012, according to the policy update published in the journal Pediatrics.

Representatives from Walgreens and CVS, both national drugstore chains with associated medical clinics at some locations, largely agree with the AAP guidelines and do not encourage people to use their services as primary care.

"We strongly encourage all patients to have a relationship with a primary care physician and medical home for ongoing medical needs and routine exams," Walgreens spokesman Jim Cohn told Reuters Health.

The statement only refers to the types of clinics that are built into other businesses, not freestanding "urgent care" clinics, which have also grown in popularity and have some of the same drawbacks.

According to the authors of the statement, taking kids to retail clinics instead of primary care pediatricians fragments care, since the kids don't always see the same medical provider. A child could have chronic ear infections or other long-term medical problems that seem to the providers at various retail clinics like unrelated single events.

Pediatricians in "pediatric medical homes," Dr. James J. Laughlin and his colleagues write, are more likely to notice patterns in the child's health over regular visits. Laughlin is a pediatrician based in Bloomington, Indiana.

Medical homes follow the traditional model of pediatric care, first outlined in 1967, in which the family and primary care provider work in collaboration for the child's medical and non-medical care, holding all of the child's medical records in one central location.

In its statement, the AAP Committee on Practice and Ambulatory Medicine also expressed concern that retail clinics may order tests and fail to follow up. Or they may have cleanliness or public health issues, given that ill people are congregating in a retail environment not subject to the same sanitation standards as a doctor's office.

The authors note that pediatric primary care doctors use visits for minor ailments as an opportunity to explore more long-term subjects, like diet and exercise, which probably do not come up at a retail clinic.

The statement largely reaffirms the AAP's position from a similar statement in 2006, which would otherwise have expired.

In the update, the committee says it still supports medical homes and opposes using retail clinics as a source of primary care for children. If communities need to use the clinics as a source of acute care when their regular pediatricians are not available, there should be a formal set of rules for a collaborative relationship.

The clinics should adhere to all standards for pediatric care and be subject to review by pediatricians, the update states. Also, all information relevant to the clinic visit should be relayed back to the pediatric medical home as soon as possible; if patients do not have a regular pediatrician, the clinic should make arrangements to establish one.

Lastly, retail clinics need formal arrangements for after-hours coverage or emergency situations at the clinics.

Walgreens Healthcare Clinics, in some Walgreens drugstores, do use evidence-based clinical guidelines and do seek to maintain continuity of care at every point, Cohn said.

"Healthcare Clinics can play an important role in improving access and bridging critical gaps in care in today's health care environment," he said.

Dr. Andrew J. Sussman, president of MinuteClinic and senior vice president/associate chief medical officer at CVS Caremark, agreed that retail-based clinics can be useful.

"We really see our role as complementary to primary care providers," he told Reuters Health.

"I agree with the ideal that they set out for a retail-based clinic," he said of the updated AAP statement. "I don't agree that we are causing fragmentation of care."

CVS uses electronic health records or fax to send visit summaries to pediatricians within 24 hours of each clinic visit, he noted.

"We strongly support the medical home," he said. "We sometimes see kids who do not have pediatric medical homes and we give parents a list of nearby pediatricians."

Sussman believes CVS is already adhering to the guidelines laid out in the statement and has been since 2006, though he would not speak for other retail medical clinics.

SOURCE: http://bit.ly/1kCYrQ1 Pediatrics, online February 24, 2014.

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