The American Academy of Pediatrics’ Retail Based Clinic Policy Work Group has a set of recommendations coming out in this month’s issue of Pediatrics. (See earlier HealthBlawg post on retail-based clinics here.) Advance notice, courtesy of Medscape (free registration required), identifies the work group’s views on the shortcomings of this model:
1. Fragmentation of care;
2. Possible effects on the quality of care;
3. Providing episodic care to children with special healthcare needs and/or chronic diseases, some of which may not be readily identifiable;
4. Lack of access to and maintenance of a complete, accessible, central health record containing all of a patient’s pertinent information;
5. The application of medical tests for the purposes of diagnoses without proper follow-up;
6. Potential public health issues that could occur when patients with contagious diseases are in a commercial retail environment (eg, mumps, measles, fevers, chicken pox, strep throat, etc); and
7. Problems in addressing concerns that require anticipatory guidance, long-term counseling, and medical supervision, such as obesity, nutrition, behavioral issues, and even immunization schedules.
These are virtually identical to the gripes one would expect pediatricians to have with use of emergency departments for primary care.
Benefits of this model that should not be overlooked may include opportunities for some children to receive care that they otherwise would not.
The retail-based clinic phenomenon very likely is here to stay, so let’s hope organized medicine will stay focused on offering constructive criticism designed to improve this addition to the health care system.
— David Harlow