ROCKY HILL, Conn. - The future of medicine in Massachusetts can be found along an unremarkable patch of suburbia south of Hartford, inside a
Her sinuses were killing her. She wanted relief. And she didn't have time to wait.
"So I came here," Albino, 52, said, her voice rasping like sandpaper. She'd just left the drugstore's MinuteClinic, a sliver of a medical office next to the photo processing counter and not far from the chew toys for dogs. "It's quick and easy. They should have done this a long time ago."
With CVS planning to open dozens of medical clinics in Massachusetts, Mayor Thomas M. Menino of Boston and other critics have warned of inferior care driven by an unquenchable profit motive. He and others predicted that in the name of convenience, patients would sacrifice an ongoing relationship with a doctor.
But interviews with a dozen independent researchers, insurers, and regulators in other states painted a far more positive portrait. Increasing evidence, they said, suggests that when patients are treated for sore throats and other minor illnesses at retail clinics, the care may actually be as good as - if not better than - in more traditional doctor offices. That is testament, in large measure, to an approach akin to a chef faithfully following a cookbook. Nurse-practitioners in the clinics use a computer-generated template that, for example, will not allow them to prescribe an antibiotic unless they first make sure the patient has no allergies to the drug.
"Frankly, from our perspective, there's a lot of good stuff in the MinuteClinic model," said Dr. Marcus Thygeson, vice president of HealthPartners, a major Minnesota medical plan whose patients have made 20,000 visits to the retail clinics in the past four years. "We like the convenience and ready access."
No state has more experience with retail clinics than Minnesota, the birthplace nearly eight years ago of MinuteClinic, which still dominates the field even as competitors crowd in. An independent, nonprofit coalition of doctors, insurers, consumers, and employers called MN Community Measurement annually rates health clinics' and doctors' practices statewide.
"Lo and behold," said Jim Chase, executive director of MN Community Measurement, "the MinuteClinic actually did very well."
The most recent report card from the group, based on data from 2006, awarded MinuteClinic the highest marks in Minnesota for treating children 2 to 18 years old for sore throats, giving it a score of 99 percent. The lowest grade: 26 percent for a doctors' group.
The high score reflects that nurse-practitioners were careful not to prescribe antibiotics for sore throats caused by viruses because the drugs are useless against viral infections. Incorrect use of antibiotics can spawn dangerous germs that are resistant to medication.
"This is not a prescription mill," said Michael Howe, the former Arby's chief executive who now leads MinuteClinic, which has 475 outlets, up from 466 just a week ago. The CVS subsidiary has never been sued for malpractice, executives said.
The clinics, which do not require appointments and stay open on evenings and weekends, treat a limited number of ailments: minor illnesses such as ear infections, poison ivy, and bronchitis. In its name and advertising slogan ("You're sick, we're quick!"), the chain trumpets a promise of speed and efficiency.
And much like a fast-food restaurant, they list set prices for medical care. In Connecticut, it's $59 for pink eye treatment, $69 for strep throat.
The nurse-practitioners in the stores are supposed to refer patients to primary care doctors, urgent care centers, or emergency rooms if a patient's medical condition falls outside the MinuteClinics' scope of care.
Mary Kate Scott, a California consultant who has extensively studied in-store clinics, said that by restricting the services they provide, "it's actually very easy to hit an extraordinarily high quality rate.
"Because you do the same thing again and again, you get extremely good at it," she said.
Retail clinics are proliferating across the nation, with a report by Scott estimating that between January 2006 and September 2007, the number grew eightfold. The expansion is being driven by twin epidemics: the aging of baby boomers and the declining number of primary care physicians.
And Massachusetts has emerged as a potentially lucrative market because the push for universal health insurance means that previously uninsured patients who skipped visits in the past are now likelier to seek out treatment.
It's hoped by sending patients with simple problems to in-store clinics, doctors and emergency rooms will have more time for cases that demand their expertise.
"Having their time available to do the complex work or to work with patients with chronic conditions really depends on us figuring out how to create a system that allows the easier stuff to get done as easily and cheaply as we can," said Margaret Laws, of the California HealthCare Foundation, which commissioned Scott's report.
"Retail clinics may be that - or may not," she said.
Concerns persist about the wisdom of offering episodic medical care inside retail outlets. Matthew C. Katz, executive director of the Connecticut State Medical Society, said members have expressed "grave concern about the continuum of care" for patients who go to store-based clinics.
Specifically, he said, doctors are worried that they're not always alerted when their patients are seen at retail clinics, which in turn creates a risk that tests will be duplicated or extra doses of the same medication might be prescribed. CVS executives said patients are asked if they have a primary care physician and a record of their clinic visit is sent to the physician if the patient permits it.
Some physicians are embracing the arrival of retail clinics. Claire Nadeau, a nurse-practitioner who manages the 16 MinuteClinics in Connecticut, said a physician who practices near the Rocky Hill CVS urges patients on his after-hours phone recording to consider going to the pharmacy for night and weekend treatment.
That is exactly what Sheree Albino did. "This was a Sunday," she said. "You can put a call into your doctor, and they have somebody get back to you. At a MinuteClinic, you might get relief a little bit sooner."
Stephen Smith can be reached at stsmith@globe.com.
