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    Will retail take over primary care?

    Walgreens and CVS pharmacy chains are aggressively developing primary care venues within their stores. Their approaches are similar yet different, although the underlying strategy is the same for both.

     

    Related: Hospitals are shifting to a retail model—will doctors follow?

     

    The idea is to deliver “episodic care” to those in need with a motto of, essentially, “you’re sick, we’re quick.” The CVS model is known as MinuteClinic with 800 units nationwide and an expectation to grow to at least 1,500. The CVS health services are staffed by nurse practitioners or physician assistants.

    CVS has relationships with physicians, available to offer advice to the NP or PA on request. Not only medical care is offered, but also counselling for nutrition, weight loss and smoking cessation. About 85% of clients have insurance and most of those have their own primary care physician (PCP).

    Recently, Target announced that it was selling its in-house pharmacies to CVS, who will in turn, run them under their own brand and in many cases open Minute Clinics in the Target stores.

    Duane Reade, a large pharmacy chain in New York City, opened primary care clinics staffed with physicians in some of its stores. Called Dr Walk-In Medical Care or sometimes “Doctor on Premises,” they found it not only very successful as a product offering, but also because it brought customers into their stores and generated downstream sales of drugs and other products.

    Customers tended to be those who might have their own PCP but who did not want to wait days to see the doctor for a minor, but troubling, issue. They found that the cost was low, the wait short and the doctor well trained.

     

    Further reading: Strategies for making PCP practices more efficient

     

    Dr Walk-In performs exams, basic treatment services, health screenings and vaccinations. The physician offers episodic and semi-urgent care, but does not invest in a PCP-patient, long-term relationship. Rather, he or she referred back to the individual’s own PCP or to a specialist if indicated.

    The clinics were highly successful and when Duane Reade was acquired by Walgreens, Walgreens decided to purchase Dr Walk-In from its founders and expand the concept nationally as Healthcare Clinic with a switch to nurse practitioners and physician assistants.

    Next: Should PCPs be worried?

    3 Comments

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    • UBM User
      As a pediatrician, in practice for 3 decades, I see retail clinics are economic tools, endorsed by insurance companies and large medical groups. Do they really improve patient care? Family Nurse Practitioners receive 120-180 hours of pediatrics training. They utilize evidence-based treatment protocols to manage the patients who come to see them. One problem is, to get to the right treatment algorithm, the correct diagnosis must be made. The other problem is, that under Stark Rules, I cannot send a patient to a lower level of care, especially for economic reasons. This rule prevents ER's from sending patients to outpatient clinics, without evaluating them first. Is the Minute Clinic the same level of care as my office, and what is my medico-legal liability if I knowingly send a child to Walgreens, he or she is mis-diagnosed and has an adverse outcome? And, has a child's medical home become his or her EHR? An unsupervised FNP managing chronic illnesses looks a lot like hospital systems competing directly with community practitioners, not withstanding all of the hospital-sponsored immediate care centers. Drive-through medicine is ever closer, as is the impersonal face on an iPad seeing patients. I hope that I don't see either. The relationships with the children and their parents are what gets me to the office every day. The erosion is real, and it seems inexorable. Unfortunately, technology accelerates much faster than our ability to understand its future implications. If there is pendulum, I hope that it swings back toward humanity.
    • [email protected]
      "Walmart Care Clinic will offer care for selected chronic conditions such as mild anxiety, asthma, uncomplicated diabetes, high blood pressure and elevated cholesterol, osteoarthritis and osteoporosis. When the requirements are beyond the scope of the nurse practitioner, the patient will be referred to an appropriate specialist." What happened to referring back to the outpatient "comprehensivist" who specializes in relationship-based, cost-saving medicine? a.k.a. the family physician?
    • [email protected]
      This is just one more blow to primary care practice. As a primary care physician (pediatrician) for forty years I have witnessed the decline of primary care.Many of my colleagues do not manage anything but the most basic problems. Much is referred to specialists. Many no longer manage hospitalized patients. Such care is relinquished to hospitalists. This is strange considering that the great majority of our residency training was in the inpatient setting. Furthermore, many primary care practices enlist non-physicians to take phone calls after hours. What is left is just the most basic and, frankly, less challenging problems. With this background it should not be surprising that national chains such as CVS and Walgreens have stepped in to offer care for these basic problems without the wait and cost. This is attractive especially for people with high deductible insurance policies. These large chain pharmacies can also obtain vaccines at a lower price than small primary care practices. The bottom line is that the future of primary care is bleak. If something is not done soon it would be difficult to imagine why medical students would chose a career in primary care and would opt instead for a medical subspecialty or surgery especially if they have a large student debt.

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