Retail-based health clinics in pharmacies or big box stores may seem more  convenient and less expensive compared to seeing a pediatrician, but these  clinics do not provide children with the high-quality, regular preventive health  care that they need, according to the American Academy of Pediatrics in an updated  policy statement released online today.

Retail-based clinics or convenient care clinics are usually run by nurse  practitioners or physician assistants that see patients quickly without  appointments and often for less money than pediatric offices or emergency  departments.  This policy statement is not totally unbiased since these  establishments compete with pediatricians for patients and profits, but the  criticisms of these offices still has validity.

The following is a list of the AAP’s concerns and my thoughts on them:

Care is fragmented.  I am glad that my  patients can go and get influenza vaccine and other immunizations that they may  need for school. However, this creates some problems. Not only do these clinics  not inform the primary office or the city-wide immunization registry about what  immunizations they have given, but they do not look at long-term problems that a  pediatrician would ask about during a visit such as school problems, excess  weight gain or emotional difficulties.

Decreased quality of care. Most of the  practitioners are not trained in pediatrics and do not know the differences in  care between adults and children.

Provision of episodic care to chronically ill children.  Simple things may not be asked that any pediatric practitioner  would know. Some examples: Do not give nasal influenza vaccine to a child with  asthma. Do not approve a child with one kidney for contact sports.  Are  chronically ill children taking their daily medicines such as penicillin in  children with sickle cell disease?

Lack of access to and inability to add to the child’s central  health record. A pattern of illness can be easily missed when all  the records are not in one place.

Use of diagnostic tests without follow up. A  primary doctor at a retail-based clinic may not know about repeated urine  infections and thus no kidney work up would be done.

Exposing a public place to infectious  children.  Although a pediatric office waiting room is not  that healthy either.

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.


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