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Retail Based Health Clinics

In the near future, retail based health clinics will again be seeking approval from the Department of Health to open in stores around the state. These clinics (Minuteclinic, RediClinic, Solantic etc) provide another entry into the medical system for our citizens.

Many patients who visit these clinics site convenience, odd hour's access and lower cost as primary drivers for their visits. In a free market, "for profit health care system" as we have in the United States, this concept offers another opportunity for a health care organization to provide services "for profit". Barring a sea change in the structure and financing of health care delivery, retail clinics continue to expand nationally and be subject to the same market forces as other elements of the health care system.

I would propose a set of fundamental requirements (based on principles adopted by the American College of Physicians), all of which must be met to provide high quality, continuous, cost efficient care:

  • The venue of care must meet strict standards for a health care facility that is administering this level of care, as set by a regulatory agency. As examples, room size, disposal of medical waste, private and confidential areas of care, infection control, state of the art equipment etc.
  • The providers must be capable of delivering care with a well defined scope of knowledge and skill set appropriate for the setting.
  • Strict evidence based guidelines and protocols should be followed by providers for all treated patients. Access to health information if needed by other health care providers should be available at the point of care. If a patient's condition worsens, a plan should be in place for further evaluation and treatment by an appropriate health care provider/facility.
  • Documentation preferably should be in electronic form with interoperable capabilities, to allow for point of care transfer of clinical information to the patient's primary care physician/medical home.
  • Prescriptions should be in electronic form and sent to the patient's choice of pharmacy.
  • Each clinic should have a referral base of medical homes for further follow-up/continuing care and/or to address other health issues.
  • The supervising physician's name should be clearly posted in patient areas, with clear directions on filing complaints with the facility and/or health regulatory agency.
  • Retail clinics should have the ability to refer patients at the point of care to other facilities within the area for health problems outside the scope of their practice.
  • Advise patients that "retail health clinics" are not to be used for continuing, long term or preventive care. This care should be provided by their primary care physician.
  • A Quality Assurance program should be in place to monitor for adherence to clinical guidelines/protocols, adverse events, lack of follow up care, patient complaints and care delivery that is "out of scope of practice".
  • A Quality Assurance program should also evaluate for clinical outcomes, cost savings and patient satisfaction.

In a "for profit" competitive environment, I would suggest that physician offices take the following measures:

  • Expand their hours and offer other payment structures, convenience and quality of care similar to retail health clinics.
  • Physician offices should create a medical home and an alliance with retail clinics for patients with no primary care physician.
  • Physician offices should accommodate these new patients as well as their established patients for follow up and continuing care in a timely manner.

If the goal is to provide integrated, coordinated, high quality, cost efficient healthcare to our citizens, the above system can fulfill these requirements if we adhere to the above principles.

N.S. Damle, MD, FACP
Governor, ACP Rhode Island Chapter
nsdamle@scim.necoxmail.com

Page updated: 11/01/07