In-store health clinics: Convenience is not enough

The AMA establishes guidelines that aim to ensure that in-store clinics don't have an adverse effect on patients' long-term health or the patient-physician relationship.

Posted Aug. 7, 2006.

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To many physicians, store-based health clinics are like kudzu, the vine that ate the South. Kudzu seemed like a good idea when it was imported from Japan years ago, mostly to stop soil erosion. Alas, kudzu grew too well and too fast -- as much one foot per day -- and overtook native trees and plants.

And just like kudzu, the growth of store-based clinics is so rapid, it's unrealistic to think it can be stopped. With that in mind, the AMA House of Delegates approved a report that provides the basis for the most effective response to the situation. The report, from the AMA's Council on Medical Services, sets guidelines for how such clinics should operate, especially when it comes to the critical issues of physician involvement and continuity of care. It also calls on continued monitoring of the growth and impact of store-based clinics.

Certainly, there's plenty going on to track. The clinics are staffed by nurse practitioners or physician assistants -- in itself, a source of concern to many physicians and to the AMA -- and are growing at the retail equivalent of a foot per day.

MinuteClinic started this wave of activity when it set up shop at a St. Paul, Minn., Cub Foods in 2000. The company now has 100 clinics in 10 cities, and it is projecting another 300 to 500 clinics during the next three to five years. (CVS, one of the nation's largest drugstore chains, in mid-July announced it would buy MinuteClinic.) Wal-Mart, the 800-pound gorilla of retailing, is opening its doors to store-based clinics. It seems every major retailer operating pharmacies is eyeing opening its own clinics or inviting an outside firm to come in and set up shop.

The clinics are touted as a practical problem solver -- again, some may think: kudzu -- for consumers and business alike. They offer convenience for time-starved patients and can be healthy for a store's bottom line.

Consider that, as the report notes, 95% of patients who receive prescriptions from these clinics fill them at the store's pharmacy. More than 50% buy something else in the store during the course of their visit.

That said, the council report noted that store-based clinics are consistent with AMA policy on pluralism in delivery and access to health care. The report also noted that the clinics have already had some patient-friendly impact on physician practices -- some have decided to remain open later or otherwise adjust their hours in response to patients' demand for convenience.

And for the most part, clinics say they're generally in sync with the standards the house passed. Among them are that the clinics should have a limited scope of services and must establish referral systems with physicians and other facilities if the patients' symptoms warrant.

But the AMA wants to ensure that store-based clinics don't have negative effects as well. Among the concerns is whether clinics will "cherry-pick" locations that have primarily an affluent customer base. That's a real possibility, given that the clinics' marketing target has changed from those without a primary physician to harried parents or suburbanites looking for quick care.

The thinking back South is that if kudzu can't be made loveable, it might at least be made manageable, as livestock forage and basket-weaving material. The stakes for patients in store-based clinics are much higher and will likely always be of concern to physicians. Sensible standards and awareness of whether they are being followed will go a long way to keep patients safe.

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External links

AMA's principles for safe and effective operation of store-based health clinics (link)

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