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Nearby Retail Clinics Don’t Decrease ED Use for Minor Ailments

November 16th, 2016

PITTSBURGH – Retail health clinics, usually located in chain drugstores, have been touted as one way to lower overall healthcare costs by diverting care of minor ailments away from expensive emergency departments.

A new RAND Corp. study, published online by Annals of Emergency Medicine, examined the experiences of more than 2,000 EDs across 23 states over a five-year period. The researchers found that the opening of nearby retail clinics was not associated with any significant reduction in visits for 11 low-acuity ailments such as respiratory infections and ear aches.

"One hope for retail clinics was that they might divert patients from making expensive visits to the emergency department for minor conditions such as bronchitis or urinary tract infections," explained lead author Grant Martsolf, PhD, MPH, a policy researcher at the Pittsburgh office of RAND, a nonprofit research organization. "But we found no evidence that this has been happening.

"Instead of lowering costs, retail clinics may be substituting for care in other settings such as primary care practices or spur some patients to seek care for problems they previously would have treated on their own,” Martsolf suggested.

The walk-up medical providers often are located in chain drugstores such as CVS or Walgreens as well as in big box stores such as Target and Wal-Mart, according to the report, which notes that care most often is provided by nurse practitioners in the retail clinics, rather than by physicians.

Retail clinics, first established in 2000, now have grown in number to nearly 2,000 and have more than 6 million patient visits annually. Because fees are lower and fewer tests are performed, the clinics tend to be less expensive than visits to EDs or even most physician offices, study authors note.

Information from the federal Healthcare Cost and Utilization Project State Emergency Department Databases from 2006 to 2012 was employed to combine emergency department use with information about the opening of retail clinics obtained from Merchant Medicine, a research firm that tracks trends in walk-in medicine.

The researchers measured retail clinic penetration as the percentage of an ED’s catchment area that overlapped with an area within a 10-minute drive of a retail clinic. Results generally indicated no relationship between the opening of retail clinics and visits to EDs for the low-acuity conditions, even when retail clinics began opening close by.

In only one case, with privately insured patients, did the study detect the slightest drop in ED use; even when patient access to retail clinics increased substantially in the hospital area, the reduction in ED visits was less than 1% among those patients.

"Retail clinics may emerge as an important location for medical care to meet increasing demand as more people become insured under the Affordable Care Act," added co-author Ateev Mehrotra, MD, an associate professor at the Harvard Medical School and an adjunct researcher at RAND. "But contrary to our expectations, we found retail clinics do not appear to be leading to meaningful reductions in low-urgency visits to hospital emergency departments."

In an accompanying commentary, Jesse Pines, MD, FACEP, of the George Washington University School of Medicine and Health Sciences in Washington, DC, suggests the situation could be improved.

"The answer is not to build more convenience settings, but to improve the value of existing settings by increasing the connectivity among providers and with longitudinal care,” Pines writes.

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