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Use of retail medical clinics continues to grow, study finds

Fast-growing retail medical clinics are attracting more older patients and delivering more preventive care, particularly flu shots and other vaccinations, according to a new study from the RAND Corporation.

Researchers found that visits to retail medical clinics increased four-fold from 2007 to 2009, with the proportion of patients over age 65 growing from 8 percent to 19 percent of all visits during this period.

More than 44 percent of visits to the clinics occurred on the weekend or other hours when physician offices typically are closed, suggesting retail clinics meet a need for convenient care, according to the study published online as a Web First by the journal Health Affairs.

"Retail medical clinics continue to grow rapidly and attract new segments of users," said lead author Dr. Ateev Mehrotra, an associate professor at the University of Pittsburgh School of Medicine and a researcher at RAND, a nonprofit research organization. "They remain just a small part of outpatient medical care, but appear to have tapped into patients' needs."

While retail clinics have begun promoting new services such as caring for chronic illnesses such as diabetes, it remains uncertain whether demand for the clinics will continue to grow as the federal Affordable Care Act is enacted.

"If demand for primary medical care drives longer wait times to see a doctor as it has following health care reform in Massachusetts, then this could drive greater demand for convenient alternatives such as retail clinics," Mehrotra said.

The study is the latest in a series of reports from RAND Health that has documented the rapid growth of retail medical clinics, which are located in drug stores or other retail businesses. The clinics typically are staffed by nurse practitioners and offer basic types of health care at clearly posted prices.

Physician groups have expressed concern that retail clinics could disrupt patients' relationships with their primary care physicians and interrupt continuity of care. The criticism has increased since some clinic operators began offering care for chronic illnesses such as asthma and high blood pressure.

Researchers examined the latest trends in the use of retail medical clinics by analyzing information from 2007 through 2009 obtained from the three largest retail clinic operators, which account for 81 percent of the clinics operated nationally. Trends in usage were compared to earlier findings from 2000 to 2006.

Visits to retail clinics reached 5.97 million in 2009, up from 1.48 million in 2007. But retail clinics still account for only a small slice of outpatient medical care when compared to the estimated 117 million emergency room visits and 577 million visits to doctors' offices made each year.

Visits to retail medical clinics for vaccinations increased sharply from 2007 to 2009, researchers found. Another recent study published by RAND researchers found that vaccination visits to the three major retail clinic chains quadrupled to more than 1.9 million in 2009. Most of the inoculations given were for influenza.

"The number of vaccinations provided at retail clinics could grow even larger if providers started counseling patients about the need for inoculations when they visit the clinics for other care," said Lori Uscher-Pines, an associate policy researcher at RAND.

In the latest study, researchers found that the proportion of retail clinics visits made for acute medical problems dropped from 78 percent to 51 percent. There was a corresponding increase in visits for preventive care, making up more than 47 percent of visits by 2009. The study does not capture the impact of a push made by retail medical clinic operators beginning in 2010 to increase the services offered for chronic illnesses.

The proportion of patients who reported that they did not have a primary care physician remained at more than 60 percent, although researchers had expected the number to drop as use of the clinics increased. They say it is possible that patients with no or weak relationships with a primary care physician are more likely to seek care at a retail clinic than patients with strong relationships with a physician.

Contact: Warren Robak
RAND Corporation

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