Where did you get your last flu shot? At the doctor’s office or at your local pharmacy? I usually go to CVS, where the wait is short, plus I get 20% off my next purchase (can be real savings with a teenage girl in the house who always has a CVS list). But have you ever had a check-up for a sore throat, cough or back pain at the drug store?
With changes to healthcare laws that are necessitating increased access to care, the “minute clinic” or retail clinic is becoming a popular and widespread concept. With nearly 1,600 of them across the country in drug, grocery and big box stores, estimates predict these numbers will double in the next few years.
I saw my first “minute clinic” last year in the back of a Duane Reade in NYC. I was immediately impressed to see a nurse practitioner at a desk, ready and waiting for a customer. What a great idea to bring healthcare to the people!
I talked to someone who recently used a minute clinic because she wasn’t feeling well, was heading out on a business trip and knew she couldn’t get in to see her regular doctor. She was diagnosed with a urinary tract infection. The NP discussed the treatment, the prescription was filled right at the store, and she was on her way. The next day, she received a voice messages from the minute clinic to find out how she was feeling, make sure she was taking the medication and inquire if she had made a follow-up appointment with her doctor. Since she felt good, was taking her meds and had made an appointment, she did not return the calls. However, the clinic kept calling her until they spoke to her. They told her they needed to talk to her directly to be sure she understood all directions and was following up appropriately. Needless to say, she was impressed and spoke highly of her experience.
But not everyone is as enthusiastic. Physicians are concerned not only that these clinics eat into their market share, but more importantly that “stop and shop” medical services may not identify clues to larger problems.
The American Academy of Pediatrics warns against using these clinics for children due to concerns over “fragmentation of care” and missed opportunities to identify more serious problems that might stem from minor complaints.
Patients are concerned about continuity of care - that an NP may not be qualified or won’t know anything about them. Others have strong attachments to their primary doctors and don’t want to give up those relationships.
I appreciate these caveats, but I think the benefits far outweigh the costs. Over the past year, I’ve been involved in national training initiatives to help providers integrate telehealth technology into clinical practice to expand access to care. As more people get insurance coverage through the Affordable Care Act, our medical systems will need to find ways to treat more patients with a variety of resources. The minute clinic can be effective with the following in mind:
Have a primary care doctor. Yes, everyone should have a doctor or clinic that has a record of your health care needs. Even if that’s your local urgent care (mine is also a family practice center), it makes good sense to have that “medical home” that knows and understands you. As noted above, this is especially true when dealing with children.
Regulations are key. There’s great potential for the success of these clinics as long as they are well staffed and regulated. I see a real opportunity for hospitals to collaborate and create partnerships or sponsor these types of clinics, providing another level of care important to consumers.
Take a collaborative approach. Retail clinics should adopt a collaborative team model with other physicians and the community. Medicine is often conducted in silos, but with technology and good practices, there is less fragmentation. The Electronic Health Record (EHR) will be required by all practitioners later this year, so having a more transparent system can start transforming the way we deliver care.
Nurse practitioners are great providers. Like any health care provider, training and supervision are essential. And a well-trained NP is an outstanding asset in any clinical setting. At my doctor’s office, I most often see the NP, and she’s great. Also, there aren’t that many primary care docs left. The vast majority of students coming out of med school are specializing, not coming out to work with the marginally ill.
Manage Change. Change is hard, and this new model is a change in something very important: the way we get our health care. Patients, providers and the general public will all have to make some changes. So some of this is good old change management. How can we engage people to do something different, something that may make them uncomfortable or threatened? Having a champion of change can be very beneficial – someone who’s already on board, who thinks it’s a good idea.
It can also help to bring in an outside person to lead change: someone objective who can help an organization implement new ways of doing things. One of the main components of the telehealth technology curriculum I teach entails helping people understand how to implement a change process. Whether you’re in healthcare or any other industry and could use some support around making change happen, I’m happy to talk to you about options for consulting or training to meet your specific needs.
What’s your experience with the Minute Clinic? Have you used one? Would you visit one for your healthcare? Share in the comments below.
To hear an excellent story on Minute Clinics, you can listen to this On Point Radio show that inspired this post.