Retail clinics could undermine primary care patient-physician relationships

Using retail walk-in health clinics, often located inside pharmacies or big-box stores, for simple acute care problems can interfere with establishing and maintaining a relationship with a primary care provider, finds a new study in the Journal of General Internal Medicine. However, this disruption does not appear to interfere with preventive care or the management of diabetes, both of which are often cited as important reasons to receive ongoing primary care from one provider.

Retail clinics are an expanding entity in the health care market, with their use increasing 10-fold between 2007 and 2009. The study authors note that health care professionals and policy makers have expressed concern that care provided by retail clinics could undermine primary care patient-physician relationships. Having limited or no access to medical records about the services provided by retail clinics has also been regarded as a potential obstacle to providing continuous care.

Researchers followed 127,358 insured patients between the ages of 18 and 65. The study focused on the year following a patient's first visit to either a retail clinic or a primary care physician for simple acute care for conditions such as an ear infection or the flu.

"On the negative side, we found patients [who used a retail clinic] were less likely to see a primary care physician for simple health concerns in the future and less likely to see the same physician more than once. However, patients who visited retail clinics were not less likely to receive preventive care or diabetes management," said Rachel O. Reid of the University of Pittsburgh School of Medicine.

It is not completely understood why using retail clinics did not translate into people receiving less preventive and chronic care, two significant goals of ongoing primary care. Reid added, "It could be that many patients who visit retail clinics do not have a primary care relationship to disrupt. Consequently, there may be a bit of a trade-off between providing access to care and addressing fragmentation of care," she said.

Valerie J. Gilchrist, M.D., chair of the department of family medicine at the University of Wisconsin School of Medicine and Public Health said, "Good primary care is good comprehensive care. We know that 11 simple, acute conditions can be managed by protocol and have pretty good outcomes, but the concern is for the transfer of medical information between retail clinics and primary care providers. If there are reoccurrences of medical issue or the results of a culture are not known, for example, this can have medical significance."

She added,"It was interesting that most of the patients who used retail clinics lived within a mile of the facility. Patients need to have access to health care, so if they are going to retail clinics because health care at a medical clinic is not available to them, then access to retail clinics may be okay for these patients."