Pittsburgh, PA—Retail health clinics, usually located in drugstores or big-box store pharmacy departments, don’t appear to have much effect on visits to nearby emergency departments for minor ailments.
A new RAND Corporation study, published online by Annals of Emergency Medicine, examined the experiences of more than 2,000 EDs across 23 states over a 5-year period to determine how they were affected by the opening of retail clinics in their neighborhoods. Results suggest no significant reduction in visits for 11 low-acuity ailments such as respiratory infections and earaches, despite the easy-to-access alternative.
“One hope for retail clinics was that they might divert patients from making expensive visits to the emergency department for minor conditions such as bronchitis or urinary tract infections,” explained lead author Grant Martsolf, PhD, MPH, a policy researcher at the Pittsburgh office of RAND, a nonprofit research organization. “But we found no evidence that this has been happening.
“Instead of lowering costs, retail clinics may be substituting for care in other settings such as primary care practices or spur some patients to seek care for problems they previously would have treated on their own,” Martsolf suggested.
The nation’s 2,000 retail clinics, first established in 2000, have more than 6 million patient visits annually. The clinics tend to be less expensive than visits to EDs or even most physician offices, study authors note, primarily because care usually is delivered by nurse practitioners and because they have lower fees and perform fewer tests.
Study authors used information from the federal Healthcare Cost and Utilization Project State Emergency Department Databases from 2006 to 2012, combining data about ED use with information about the opening of retail clinics obtained from Merchant Medicine, a research firm that tracks trends in walk-in medicine.
Retail clinical penetration was measured as the percentage of an ED’s catchment area that overlapped with a 10-minute drive of a retail clinic. Yet, according to the results, no relationship was generally indicated between the opening of retail clinics and visits to EDs for the low-acuity conditions, even if close by.
In only one situation, with privately insured patients, did the study detect the slightest drop in ED use. Even when patient access to retail clinics increased substantially in the hospital area, the reduction in ED visits was less than 1% among those patients.
“Retail clinics may emerge as an important location for medical care to meet increasing demand as more people become insured under the Affordable Care Act,” added co-author Ateev Mehrotra, MD, an associate professor at the Harvard Medical School and an adjunct researcher at RAND. “But contrary to our expectations, we found retail clinics do not appear to be leading to meaningful reductions in low-urgency visits to hospital emergency departments.”
As for what can be done about that, an accompanying editorial by Jesse Pines, MD, FACEP, of the George Washington University School of Medicine and Health Sciences in Washington, DC, suggests the following: “The answer is not to build more convenience settings, but to improve the value of existing settings by increasing the connectivity among providers and with longitudinal care.”
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