Are in-store clinics the prescription we need?

(PAUL LACHINE ILLUSTRATION)

MAYOR MENINO is wrong to oppose retail clinics ("Menino decries clinics in retailers," City & Region, Jan. 11). As a working parent, I speak for many taxpayers and healthcare consumers. None of Boston's public or private hospitals is able or inclined to open and manage as many small neighborhood clinics as there are CVS stores in the state. Yet this is exactly what we need: numerous, accessible, small clinics throughout cities and towns, open nights and weekends, for all the minor ailments of growing children and aging adults. A 15-minute visit with a nurse on a weekend saves a day of lost work, missed school, and travel time in visiting a pediatrician or primary care physician.

The mayor's argument -"Allowing retailers to make money off of sick people is wrong" - is sadly laughable in light of the profits reaped by the health insurance industry.

Hospital emergency rooms are overwhelmed by non-emergency visits, increasing our insurance costs. A shortage of primary care physicians causes months-long waits. And this is before the addition of 300,000 newly insured state residents. Providers and the mayor should welcome MinuteClinics as a timely answer to acute needs.

C. COUSINEAU
Marblehead

THE PUBLIC Health Council's approval of the proposal to allow CVS to operate store-based medical clinics may have been reasonable, but the concerns raised during the council's extended deliberations remain ("In-store healthcare wins state approval," Page A1, Jan. 10). These facilities may ease access problems for some, but no good, independent data exist from other states where similar facilities have been operating to show what the effects are likely to be.

What will happen when patients appear at a site with illnesses that are more serious than the nurse practitioners can treat? (CVS says staff are trained to recognize those conditions and to refer patients elsewhere.) How many patients will develop avoidable drug interactions because CVS clinic staff will not have access to patients' prior medical records? If things do go wrong, who is responsible - the nurse practitioner, CVS, or the patient's regular doctor? Will hospital emergency departments see fewer patients needing routine care, as hoped, or will the services provided in the CVS clinics be for conditions that would have disappeared by morning? Finally, how will CVS management and clinical staff compensate if these facilities fail to generate the expected profits?

Since the first clinics will not open until fall, the state has time to plan good studies to answer these and other important questions.

STEPHEN M. DAVIDSON
Professor, Boston University School of Management
Boston

DR. JEFFREY Fine's tirade ("Shifting patients," Letters, Jan. 12) against CVS's plan to provide walk-in clinics is understandable. After all, these clinics will represent competition.

Fine's assertion that patients who would use such clinics are the same ones who abuse the system by using hospitals for primary care blames the victims for a system that leaves them without accessible primary care when they need it.

Further, his statement that such clinics "will not save insurance costs" is nonsense. The average cost of a visit to these clinics is estimated at $59. The same care in a hospital emergency room would cost many times that amount.

Fine worries that these clinics "will deprive primary care doctors of revenue." Maybe it will also motivate some of them to better serve walk-in patients.

Fine rails against change instead of becoming an agent of change in a healthcare system desperately in need of it.

JOHN LYNCH
Holliston

AS A nurse practitioner practicing for 16 years in a community health center, I am appalled by the suggestion that my practice standards or those of my colleagues would be swayed by our place of employment. Both Mayor Menino, by implication in his comments, and Drs. Carolyn and Paul Sax, in their Jan. 15 letter "In-store clinics a concern to some, a relief to others," impugn our professional integrity.

As the Saxes must know from their own work with nurse practitioners, the concern about antibiotic resistance is a major clinical issue, not only for pediatricians and specialists but for those of us in general practice. It is not "inevitable" that professionals would subvert their standards of appropriate, evidence-based care to the profit motive.

I'd invite my colleagues to substitute the word "physician" for "nurse practitioner" in the statement "A nurse practitioner employed by the pharmacy would be motivated to prescribe an antibiotic, even when not necessary" to see whether it still rings true.

JOHN ROBERTS
Dorchester

AT FIRST glance, limited-service health clinics in retail stores could offer quick access for patients who have relatively straightforward ailments. However, these types of operations only perpetuate the current reality: patients making visits for episodic treatment rather than being able to connect to a continuous source of healthcare. Rather than endorsing this undesirable scenario, we should be making it more possible for patients to find a medical home with a provider and facility that support regular access, comprehensive care, and a commitment to reducing racial and ethnic health disparities.

Community health centers offer this environment to consumers. Yet the Public Health Council's approval of limited-service clinic licenses could dilute this strong system of primary care and safety net for the medically disenfranchised. We support Mayor Menino's stance in opposition to limited-service clinic licenses. Instead of re-creating systems of fragmented care, we should be strengthening the valuable resources we have.

JOEL ABRAMS
BILL WALCZAK
Dorchester
Abrams is the CEO of Dorchester House Multi-Service Center.
Walczak is the CEO of Codman Square Health Center.