Retail clinics draw patients without primary care doctors, study reports

By Elizabeth Cooney, Globe Correspondent

People who go to retail clinics for treatment of simple medical problems often don't have primary care providers to turn to, according to a national study appearing days after Massachusetts approved licenses for its first two drugstore clinics.

The Health Affairs study, conducted by the RAND research organization, is one of the first to compare people who seek medical help at retail clinics with patients of primary care physicians. Retail clinics, including the CVS-owned MinuteClinics that will open next month in Medway and Tewksbury, are staffed by nurse practitioners

Doctors in Massachusetts and across the country have opposed the retail clinics, saying they jeopardize the doctor-patient relationship and further splinter the healthcare system. Public health experts argue that the clinics expand access for people who otherwise might not get appropriate care for their sore throats or ear infections, winding up in emergency rooms when no other option is available.

The RAND researchers, who analyzed 1.35 million retail clinic visits from 2000 to 2007, report that these clinic patients were less likely to have a regular physician than the US population as a whole. They were also more likely to be 18 to 43 years old than patients at primary care offices, according to national data on outpatient care. Most patients were using insurance to pay for their retail clinic visits, the study found. A separate article in Health Affairs says that retail clinic care costs about a third less than care in doctors' offices or urgent care clinics.

"Patients who don't have a primary care provider and yet need occasional acute care are probably more likely to be using urgent care or the emergency departments when they need care," lead author Dr. Ateev Mehrotra, a health policy analyst at RAND, said in an interview. "There are patients who are not well-served by the current healthcare system and really value convenience for simple acute care over the relationship they might have with a primary care provider. Many don't have a primary care provider."

In 90 percent of the retail clinic visits, patients were seeking treatment for the same cluster of problems: upper respiratory infections, sinusitis, bronchitis, sore throats, ear infections, conjunctivitis, or urinary tract infections. Flu shots, other immunizations, and blood-pressure checks were also common.

Mehrotra, who is also an assistant professor at the University of Pittsburgh School of Medicine, said retail clinic visits for simple conditions like these can complement care for more complicated issues or chronic diseases that would be managed by the patients' primary care physicians.

"We don't know whether these kinds of visits are going to disrupt primary care relationships," he said. "The majority didn't have a primary care physician so they didn't have relationships to disrupt."

In Massachusetts, the retail clinics are required to keep a list of primary care providers who are accepting new patients, among other regulations.

"These clinics are not meant to be a substitute for comprehensive primary care," Donna Rheaume, a spokeswoman for the state Department of Public Health, said in an e-mail interview. "We do believe that they will make care for the treatment of minor health issues more convenient for people. They will also provide care for these minor ailments in low-cost settings rather than emergency rooms – which is important as we continue to support the success of heath care reform in Massachusetts."