Primary/urgent care waiting room

Our waiting room

In August 2014, Consumer Reports will publish an article discussing the relative merits of Urgent care vs retail clinic vs emergency room care. They ask “Can you really get quality medical care at a Retail Clinic?

Evidence suggests you can, at least across the relatively narrow range of conditions that the clinics treat. In a study published in 2009 in the Annals of Internal Medicine, researchers at the RAND Corporation, a nonprofit research institute, eval­uated the care given for three common illnesses—urinary tract infection, sore throat, and ear infection—at a group of clinics inside retail stores in Minnesota.

They found that the level of care was similar at retail clinics, urgent-care centers, and doctor’s offices—but lower at emergency departments.

“Retail-store clinics serve a purpose at present,” Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser since 1967, said. “They have leapt into the void by providing services for run-of-the-mill acute problems at times when patients can’t always get in to see their primary care doctor and emergency rooms are overcrowded.”

Not everyone is a fan of retail-based health care. Here are two of the main drawbacks and what to do about them.

1. They may disrupt ‘continuity of care’: At Evolve Direct Primary Care, we offer both primary care and urgent care. If someone chooses to follow up elsewhere, they will automatically have a complete record of everything we have done at our office, including our office notes. This should resolve the concerns that some doctors have that walk-in clinics interfere with what’s known as continuity of care, meaning patients aren’t receiving treatment from the same doctor over time. That may be especially risky if you suffer from a chronic condition such as diabetes or high blood pressure. But about 62 million Americans—including many with insurance—have little or no access to primary care, because they either don’t have a doctor or can’t easily get an appointment when they need one. At Evolve, we believe everyone deserves to have easy, fast and affordable access to healthcare providers.

2. They may not be the best option for kids. At Evolve, we agree with this statement and therefore only see children ages 12 and up. We offer free memberships for any kids ages 12-25 if their parents are members. But for younger kids under 12, we agree with the American Academy of Pediatrics’s February 2014 statement wherein they advised parents to stay away from retail clinics because they don’t have complete health records on young patients and the care may be lacking in quality (for example, the clinics’ practitioners may overprescribe antibiotics). But the RAND study found no evidence to support those concerns.

3 walk-in options
Retail clinics aren’t for emergencies; for those, you still need to call 911 or head to the nearest emergency room. Here’s a comparison of the available quick-care options.

Retail clinic
A walk-in clinic inside a retail store with an on-site pharmacy; major players include CVS, Target, Walgreens, and  Walmart.
Mainly nurse practitioners—nurses with advanced training who can prescribe medication and practice independently in some states.
About 1,700
Vaccines; ailments that are bothersome but not life-threatening, including bronchitis, ear infections, minor sprains, sore throat, and urinary tract infections.
Average cost: $110

Urgent-care center
A walk-in center owned by a hospital, group of doctors, or independent investors that provides extended hours and is open on weekends.
A physician who specializes in family or emergency medicine; a physician assistant, nurse, or radiologist may also be on site.
Problems that are urgent but not severe enough to warrant a trip to the ER, such as a fracture or deep cut that may need stitches.
Average cost: $156

Emergency room
A hospital department equipped to treat life-threatening emergencies around the clock.
Emergency-medicine physicians, nurses, physician assistants, specialists.

Situations that threaten  “life or limb,” such as difficulty breathing, chest pain, seizures, head trauma, vomiting blood, severe allergic reaction, or loss of consciousness.
Average cost: $570
*Represents average amount billed to patient and/or his insurer (plus patient co-pay). Figures are from 2009 Annals of Internal Medicine study.

Editor’s Note: This review of an article which appeared in the August 2014 issue of Consumer Reports magazine. We hope we have been able to summarize and review their recommendations and add some clarity.