When it comes to treating their kids’ cuts and bruises, more parents are turning to the convenience of retail pediatric clinics. Are they a good substitute for the pediatrician’s office?
In a study published in JAMA Pediatrics, researchers from Washington University School of Medicine, St. Louis report that even families with well-established relationships with a pediatrician take advantage of pediatric retail clinics to take care of their children’s minor health issues, even if they are staffed with non-pediatric health care personnel.
Why? The researchers surveyed 1,484 parents from 19 Midwestern pediatric practices who said that they took their kids to the clinics out of convenience; 74% of the parents said they first considered going to their pediatrician, but 37% decided on the retail clinic because it had hours that conformed better with their schedules.
In a corresponding editorial, Dr. Edward Schor of the Lucille Packard Foundation for Children’s Health in Palo Alto, California wrote that such decisions may become more commonplace: “Retail-based clinics reflect systemic changes occurring within the health care industry to which pediatric practices must adapt.” Retail clinics, which are typically run by nurse practitioners and physician assistants, are not only convenient, but cost patients about 30% to 40% less than office practices. Most of these clinics are located in retail pharmacy stores, while others are operated by hospitals or doctors’ groups.
The lower cost and increased convenience of the clinics are putting pediatricians on the defensive, and the American Academy of Pediatrics (AAP) formally opposes them as an appropriate venue for care of infants and children. AAP officials question the quality of care patients receive, stemming from the fact that children may see different practitioners at each visit.
“The AAP supports that concept of the medical home, a place where all care records are kept and where care is coordinated. Retail-based clinics don’t fit well in that model,” says Dr. Anne Francis, a clinical professor of pediatrics at the University of Rochester School of Medicine and Dentistry and co-author of the AAP Principles Concerning Retail-Based Clinics. “Retail-based clinics have established a niche for quick convenient care. They are poor choices for evaluating sick children, especially younger children. [They] are not the place for children and adolescents to get ongoing care for chronic conditions and not the place to have physicals for school or sports. The lack of access to the complete medical record and appropriate screening surveys and tools make this a poor choice for pediatric care.”
The AAP’s concerns are centered around four issues:
- Fragmented services: In most cases, retail clinic practitioners don’t access a child’s health record and treat only isolated symptoms such as sore throats and ear infections.
- Lack of training in pediatric care: “Rather, [these are] folks who have had minimal pediatric exposure,” says Francis, and fevers in a adult may signal different health concerns than those in two-year olds.
- Lack of follow-up: While parents can bring their children back to the clinics, in most cases the services are meant as a stop-gap to fulfill immediate health needs. “For example, if a practitioner sees a four year-old at 7 p.m. and that child has a febrile seizure at 11 p.m., will the retail-based clinic be able to respond?” says Francis.
- Public setting: Not all clinics offer private examination rooms, which might be a concern for some parents who are uncomfortable discussing their children’ or their families’ health issues.
With more patients starting to take advantage of the clinics, however, pediatricians may need to learn some lessons about what these centers are doing right and make adjustments in their own practices, such as becoming more available for their patients. “Generations ago, many physicians subjugated their own needs and those of their families to meet the needs of their patients,” wrote Schor. “Times have changed and the balance has shifted, but the needs of patients have not. To meet our responsibilities, practices must change.”
One example of such an evolution are pediatric urgent care centers, which provide more extensive health services, such as minor procedures, X-ray and other diagnostic tests. The five clinics run by Children’s Healthcare of Atlanta is one of the oldest pediatric urgent care networks in the country, established around 20 years ago, and serves as a satellite facility for the region’s three major hospitals. “We see about 130,000 patients a year at five different locations,” says Dr. Usha Sathian, the practice director of urgent care and primary care, for Children’s Healthcare of Atlanta. “We work with physicians who are credentialed and affiliated with Children’s Healthcare of Atlanta all over the city, and the majority are pediatricians.”
Sathian says the urgent care centers are designed to supplement the care that children receive on a regular basis from their pediatricians, or their medical home. “Over the years it has become very clear that convenience is an issue especially when both parents are working and there are traffic battles like here in Atlanta and not every child gets a healthcare provider,” she says. “We have thrived because we offer the pediatric differential, . Because we believe in the medical home, we always send these children back to their providers for follow-up.”
Telehealth represents another way that pediatricians can provide services more conveniently. Francis, who practices at Elmwood Pediatric Group in Rochester, New York, says the office has a telehealth program in one of the city day care centers. If a child becomes ill, the daycare provider can contact the telehealth provider who can examine the child’s ear and throat, and listen to the child’s lungs–all over a video monitor. By the time the parent picks up the child, the doctors have already diagnosed, say, an ear infection and a prescription to treat it is waiting for them, delivered by a nearby pharmacy.
“With the rapid emergence of apps for smart phones, I can easily imagine a time when many of our in office visits are replaced by electronic visits,” says Francis.
It’s the pediatricians’ answer to the retail clinics, and while it’s not clear which strategy will win out — or whether patients will demand a blend of both — it’s obvious that patients are no longer satisfied with getting their care the traditional way.