Practice picks a spot where the patients are

While the typical grocery list includes items like milk, butter and eggs, some shoppers at a Milwaukee store also get physical examinations, throat cultures and blood draws.

In yet another example of physicians going to where the patients are, one primary care group practices out of a Pick'n Save store, mere steps from the deli counter and bread aisle.

From a traditional perspective, it's an odd fit. But the clinic, run cooperatively by Aurora Health Care, a nonprofit network of physicians, hospitals and pharmacies in eastern Wisconsin; and the University of Wisconsin Medical School, Madison, also can be viewed as a tool for reaching out to those in an underserved community who need primary care.

"The office is right across from the pharmacy, so it's not unheard of for a [clinician] to walk across with a patient to pick up medication," said Nick Turkal, MD, a family physician, senior clinical vice president and chief medical officer for Aurora Health Care. "And going a step further, with some diabetic patients, they'll take them out into the store and help them shop better."

The location gives the practice tremendous visibility, especially compared with a typical medical office building. Outside the office, the clinic uses bulletin boards and running videos to highlight certain health topics for current and potentially new patients. While some patients may have viewed the clinic with a skeptical eye when it initially opened several years ago, the schedule is always full now, said Janice Litza, MD, a family physician, medical director of the clinic and an assistant professor with the University of Wisconsin.

"It took some time to establish some credibility," she said. "It took some time to establish that we are a quality clinic. Once people got comfortable with that, we got very busy."

Patients have to enter the store to get to the clinic, but otherwise, it's a typical professional office. The store's extended hours and security also made it possible for the clinic to stay open at night and on the weekends to provide urgent care services. Before moving into the space, the clinic operated out of an office building without the same kind of protective environment, so safety was a concern, Aurora directors said.

The clinic employs two physicians full time and one part time, and it uses a stable of residents and two part-time nurse practitioners as well. One drawback, however, is the clinic is sandwiched between a bank and a food court, so it has nowhere to expand. The fact that the clinic can worry about needing more space, though, is a measure of the public response.

Aurora has employed a similar theory in visibility through its latest initiative, a collection of kiosks at pharmacies, offering diagnosis and treatment for common ailments.

The program, called Aurora Quick Care, offers tests to confirm strep throat, ear infections and similar ailments that sometimes can send a patient to the emergency department if they strike at an odd time. The cash-only kiosks are staffed by a nurse practitioner, and visits cost $30.

Two kiosks are open at Aurora-owned pharmacies, and the organization expects six to be open by the end of the year.

"This is not a replacement product for primary care," Dr. Turkal said. "This allows us to treat, triage, and get them set up with a primary care physician who can meet their needs."

The goal of the program is to offer a convenient, affordable alternative to local emergency departments, which often are overcrowded with people who don't necessarily need emergency care. Less stress on the emergency system can mean less overall cost as well, Aurora officials said.

It also can be an effective marketing strategy, as being out in the community can land more patients. While the kiosks have been successful so far, Dr. Turkal said it wasn't very likely the Quick Care program would employ physicians to staff them, despite the ability to then offer more services.

"The goal is to have it for limited diagnoses," he said.