Do Retail Medical Centers Provide Quality Care?

Since the first one opened in 2000, retail medical clinics, such as those set up in grocery stores and pharmacies, have become increasingly widespread. There are currently about 1,200 of these in-store clinics in the United States, and more than 6,000 are expected to open across the country within five years. Typically staffed by nurse practitioners, these clinics offer care for minor illnesses, including coughs, body aches, and itchy eyes; perform routine exams, like college and camp physicals, and vaccinations; as well as providing diabetes and cholesterol screening. No appointment is required, there is little to no wait time and the clinics have convenient evening and weekend hours.

Retail clinics have already served more than 3.5 million patients, according to industry group Convenient Care Association, and surveys of patients who received care at them have been positive, but some doctors groups, such as the American Academy of Pediatrics, have expressed concerns that the clinics provide a lower quality of care than traditional medical facilities, have greater rates of misdiagnosis, and over-prescribe antibiotics.   

To find out more about the quality and effectiveness of retail clinics, Dr. Ateev Mehrotra, assistant professor at the University of Pittsburgh School of Medicine and a policy analyst at the Rand Health Research Institute, and colleagues analyzed insurance data on 2,100 Minnesotans treated at retail clinics between 2005 and 2006 for middle ear infections, sore throats and urinary tract infections—three diagnoses that made up a combined 40 percent of the clinics’ caseload. They judged the quality of care by 14 different measures, including what kinds of tests were performed, what drugs were prescribed and whether follow-up visits were scheduled.

The team found that the standard of care in the Minnesota clinics, including the frequency and type of laboratory tests performed and drugs prescribed for those three ailments, were consistent with doctors’ offices and urgent care centers and slightly better than at emergency rooms. No significant misdiagnoses were detected and the costs at the retail clinics were 30 to 40 percent lower than in doctors’ offices and urgent care centers. “These findings provide more evidence that retail clinics are an innovative way of delivering health care,” Mehrotra said. “Retail clinics are more convenient for patients, less costly and provide care that is of equal quality.”

However others, including Dr. Scott D. Hayworth, chief executive officer of Mount Kisco Medical Group in New York, remain unconvinced, arguing that physicians provide more comprehensive and expert care, and they know their patients’ medical history. “These (clinics) are clearly picking a few minor ailments, which tend to be less expensive to treat,” he said. “When you have more serious illnesses, you need more back-up.” Hayworth says nurse practitioners and physician assistants (PAs) are effective in traditional settings where there are supervising doctors. “Say a sore throat turns out to be something more serious. A PA may miss that diagnosis.”

Anne Pohnert, a nurse practitioner at Minute Clinics in Northern Virginia, disagrees, pointing out that many of the basic tests available in urgent care facilities and emergency rooms, such as urinalysis, rapid strep throat testing, and rapid flu testing, are also offered in retail clinics. “We are acutely aware of what’s safe in our setting and what’s not,” she said. Pohnert notes that the electronic medical system used by Minute Clinic alerts the user to a potential bad drug interaction—an advantage that not even every doctor’s office has. And each Minute Clinic has a list of local primary-care physicians, urgent care centers and hospitals for patient referrals.

Mehrotra acknowledges limitations in the study, such as being based entirely on data from one state and focusing on only three diagnoses, but says it still provides evidence that retail clinics have a place in the health-care system. “They’re serving a patient population that’s not frequently going to a primary-care physician,” he said. “To that degree, retail clinics can improve access to care. In a setting like where we’re in right now, where a lot of people need to get flu shots, they’re just another way—a convenient way—for people to get those.”

The study is published in the Annals of Internal Medicine.