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October 28, 2015
Physician Group Opposes Chronic Care From Retail
Health Clinics Philadelphia—A major organization of internal medicine physicians is publicizing its position on how patients should use retail health clinics located in pharmacies and other retail establishments. In essence, it urges that patients visit the facilities only as a backup alternative to primary care physicians for the diagnosis and treatment of episodic minor illnesses. While much of the position paper by the American College of Physicians (ACP), published recently in Annals of Internal Medicine, calls for better communication, it also maintains that “insufficient data” exists for chronic care management by retail health clinics. It also argues against direct referral to medical specialists from the clinics and insists clinics have the responsibility of informing primary care physicians of any visit activity, including vaccinations. “Health care delivery models are changing and our patients are embracing and exploring alternatives to the traditional office practice,” ACP President Wayne J. Riley, MD, MPH, MBA, said in announcing the release of “Retail Health Clinics: A Policy Position Paper of the American College of Physicians.” Riley added that the ACP, which maintains that every patient should have an ongoing relationship with a primary care physician, “feels it is important to provide guidance to physicians and their patients allowing them to understand the role retail health clinics may have in providing quick, convenient and patient-centered care.” Key to that is the insistence that retail health clinics should serve as an episodic alternative to care for relatively healthy patients without complex medical histories. The position paper, which points out that retail clinics have limited space and infrastructure, suggests that the primary usefulness of the alternative care settings is their more flexible scheduling and provision of after-hours care. Physicians should discuss with their patients circumstances in which the use of a retail health clinic might be appropriate and how they should follow up, the ACP says. The position paper also stresses that retail clinics should use a structured referral system to primary care settings and encourage their patients to establish a relationship with a primary care physician if one does not already exist. Because of a possible disruption in continuity of care, the ACP opposes referral of patients directly to subspecialists without consultation by a primary care clinician. In addition, the internal medicine association argues that retail health clinics have a primary responsibility to promptly communicate information about a visit to a patient's primary care physician, including but not limited to the administration of any vaccination, prescriptions, tests, or post-care instructions. At this point, ACP comes out against chronic disease management in the retail health clinic setting. Instead, the physician group calls for controlled research into the safety, efficacy, and cost effectiveness of chronic disease management in the retail health clinic setting.
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