September 9, 2014

Do You Use Your Local CVS or Walmart Walk-In Clinic for Medical Services?

Are those clinics – the facilities you see at CVS, Walmart, Walgreens – a good idea?

If used wisely, yes.

Their very existence is an indication of American business ingenuity. These clinics also show just how inadequate the American healthcare system is at the moment.

As reported in a recent article in the Washington Post’s Health & Science section, the USA has the most alarming shortage of primary care physicians of any developed country in the world. Nearly three out of four Americans cannot readily access medical care at night, on weekends or holidays unless they go to an emergency room.

Enter the realm of quick-care medical services: those walk-in clinics at local pharmacies – typically staffed by nurse practitioners – or free-standing urgent care centers, where physicians are usually in charge.

No question: these places fill a need. In addition, the price is usually right, and the waiting time is almost always better than it is at the local hospital’s crowded emergency room. They also provide healthcare services to the millions of Americans who do not have their own primary care doctor. Nearly 40% of all visitors to these clinics do not have their own GPs.

Comparative Study Validates Clinic Use
In 2009, the Annals of Internal Medicine published a study that compared the care provided for urinary tract infections, sore throats, and ear infections at walk-in clinics, urgent care centers, and emergency rooms… all in Minnesota.

Using 14 generally accepted indicators of quality, the survey discovered that ratings were similar among clinics, centers, and doctors’ offices… but lower in hospital emergency rooms.

Said study leader Ateev Mehrotra, associate professor at Harvard Medical School and a policy analyst at the Rand Corporation, “The takeaway is that most people who use a walk-in clinic should feel reassured.”

Nearly 99% of all clinics in America belong to the Convenient Care Association, an industry group that sets standards. That membership means – among other things – that participating clinics use electronic medical records, and that they inform the patient’s primary care doctor what has happened there… if the patient agrees (and if she has a doctor in the first place).

Clinics Expand Services, Generate New Criticisms
Recently, walk-in clinics have begun doing more than just treating acute medical issues – initially their primary function. They’ve expanded into new territory of managing chronic conditions -- like high blood pressure, diabetes, and asthma.

That service expansion raised a red flag.

Marvin M. Lipman, Consumer Reports’ chief medical adviser since 1967, said, “Complex or chronic medical problems that require continuity of care do not belong in retail clinics, period.” In such cases, he explained, patients need a consistent primary-care provider or specialist to manage and monitor the condition over time.

There’s another issue: conflict of interest. Clinics based in facilities that provide pharmacy services – where there may be pressure to generate profits -- might have incentive to prescribe unnecessary meds. 

A Few Guidelines
The medical experts at Consumer Reports provided these guidelines for walk-in clinics and urgent-care centers:
  • Make sure you go to the right facility. Retail clinics are appropriate for routine ailments or services: a flu or shingles shot, a strep test, a camp physical for a child. For something more urgent, such as a broken bone or a cut requiring stitches, go to an urgent-care center. (Make sure the physician on-site is board-certified.) For more-serious or life-threatening problems, dial 911 or get to an ER.
  • Get everything that happened at the clinic in writing. That includes any diagnosis you get, instructions for follow-up care, the name of who treated you and any drugs prescribed or recommended.
  • If you have a chronic condition such as diabetes or heart disease and can’t easily get in to see your primary-care doctor or regular specialist when you need to, consider looking for another doctor. Thanks to incentives under the Affordable Care Act, more private practices are adopting weekend hours and allowing walk-in or same-day appointments.
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I’ve used my own local CVS walk-in clinic, and was pleased with the service. While most of my issues are chronic, complicated, and continuing – thereby requiring oversight by regular specialists – I’d use the clinic again for routine, acute issues. Here are two earlier commentaries:

1 comment: said...

The concept of walk-in clinics is very good. In most cases they provide high quality services without long waits.
Two weeks ago, I took my wife to such a clinic for ear wax removal. The practitioner perforated her ear drum. Infection set in immediately and she has required fairly extensive follow up by a specialist.
We didn't save time or money and have experienced severe consequences. This was probably a very unusual case.