Health Care at the Drugstore: Should You Go to a Retail Clinic?

Skeptical? Consider the recent findings from Rand Health, the policy research group that examined records from 2,100 retail clinic visits for earaches, sore throats, and urinary tract infections. “Our study does not find any evidence that quality of care is inferior,” says Dr. Ateev Mehrotra, a University of Pittsburgh Medical School professor and lead author of the study. “If you are able to see your doctor, then you should. But if he or she is not available, the retail clinic is a good alternative.”

The in-store clinics are spreading like H1N1 — there are now about 1,000 of them, spread through 37 states — and gaining credibility. For example, the leading chain, CVS MinuteClinic, has a partnership with Cleveland Clinic.

“In our organization, we’ve put a great deal of effort to providing same-day access — but it ain’t good enough,” says Dr. David Bronson, chairman of the Cleveland Clinic Medicine Institute. “A patient of one of my associates called at 11:00 a.m. saying she was sick,” he adds. “He said he could see her at 4. She went to the retail clinic at 1:00.”

And remember, you’re not heading in there for bypass surgery. The top 10 reasons people visit one are upper respiratory infection, cold symptoms, bronchitis, sore throat, ear infection, swimmer’s ear, conjunctivitis, urinary tract infection, blood pressure check, and immunizations and screening tests.

The store clinics usually operate daily from early morning until early evening, catering to families in which both adults work. Unlike the 8,000 “doc-in-the-box” urgent care centers — which often have a doctor on staff in addition to nurse practitioners or physician assistants and complex diagnostic equipment — retail clinics are pared-down operations. They’re usually staffed by one nurse practitioner or physician assistant who does it all: He or she will take your insurance card, conduct the examination, and write the prescription. The clinics typically have relationships with local physicians, who provide advice on protocols.

The clinics are not without controversy. The American Academy of Pediatrics, in particular, has issued warnings about their possible disruption to the primary patient-physician relationship, potential for overprescription of medications, and missed opportunities for preventative care for children.

But Rand Health says patients get treated very well. “If anything, nurse practitioners take more time with patients than doctors do,” says Mehrotra. And Bronson doesn’t believe the clinics overprescribe. “Retail clinics have been under such scrutiny from state medical boards and nursing boards that, in my experience, they’ve been very cautious about issues like overprescribing antibiotics,” he says.

Of course, you shouldn’t go to a retail clinic for a serious emergency — if you think you have appendicitis, get yourself to the hospital. CVS is not the place for your annual checkup, either. And babies are not us: Most clinics won’t see children under 2.

Still, in the following instances, a store clinic can be just what the doctor ordered.

• Preventive care: Retail clinics excel at providing quick, inexpensive flu shots and wellness exams, such as children’s sports physicals. While the H1N1 panic has caused spot shortages of vaccines at some retail clinics, MinuteClinic and Walgreens Take Care say they have delivered many more shots than last year.
• Minor after-hours maladies or injuries: The nurse practitioners can check out a twisted ankle or perform simple tests such as a strep throat culture. “Usually it’s common family things like ear infections, bronchitis, pinkeye, and school physicals — services that people don’t want to wait for,” says Donna Haugland, chief nursing officer of CVS MinuteClinic.

Clinics can’t order blood work or X-rays. And they’re not equipped to handle broken bones or complex chronic health conditions. Sometimes, during the clinic visit, you’ll be instructed to get to a doctor quickly. “We can see someone with an uncomplicated urinary tract infection, but if we then see back tenderness, which can be an indication for a kidney infection, we will send them to the urgent care center. And if we think it’s necessary, we will call the ambulance,” says Haugland.

Prices depend on the reason for the visit, but they’re generally pretty inexpensive. At CVS MinuteClinic, an exam for a minor illness, injury, or skin condition costs $62, wellness visits are $20 to $66, and vaccinations run $30 to $112. According to Rand Health, the average cost of care over the course of an illness is $110 at retail clinics, compared with $156 at urgent care centers, $166 for family doctors, and $570 for emergency room visits.

And yes, the clinics take insurance. Generally, retail clinic visits have the same co-payments as urgent care centers or doctors’ offices. But some insurers, such as Blue Cross/Blue Shield of Minnesota, now waive the co-payments for clinic patients. And more are likely to follow, since the clinics keep medical costs down for insurers. “Retail clinics are here to stay,” says Bronson. “That is the reality.”

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