How to Integrate Clinics

If an in-store clinic has not appearednear you, it probably will soon.Hundreds of these mini-clinics arealready operating in the major chaindrugstores and other retailers, and thousandsmore are scheduled to open in thenext few years.

Many chains already seem convincedthat these clinics, typically staffed bynurse practitioners and physician's assistantsand offering basic medical services,can increase revenue and drive morebusiness through the pharmacy. Someestimates suggest that around 90% ofthe prescriptions generated at these clinicsare filled at the in-store pharmacy.

Yet, will employers continue to valuepharmacists as highly if services can beprovided by clinics at lower cost? Couldincreasing reliance on clinics threatenpotential growth areas for pharmacy, suchas medication therapy management?

A second concern is whether thetrend will change the way patients viewpharmacists. If patients rely on the clinic'snurse practitioners for diagnosis, willthey also rely on the clinic for advice thatwould previously have been provided bypharmacists? Will they be less likely to goto the pharmacy for advice about OTCdrugs, for example?

These concerns are understandable.They do not mean, however, that miniclinicsshould be seen as a bad thing. Onthe contrary, the surging growth of theseclinics could be a positive development.It is clearly necessary, however, to examinewhat the pharmacist's role should beand how we can best adapt to the clinicphenomenon.

We can start by developing a goodworking relationship with the clinic,encouraging the clinic's staff to referpatients with drug therapy managementquestions to us, for instance.

On a larger scale, we need guidelinesfor the relationship between the pharmacyand the clinic. Today, the AmericanMedical Association (AMA) has a set ofprinciples for store-based health clinics,covering such areas as clinics' responsibilityto refer patients to physicians whenthe patients' needs are beyond thescope of the clinic's services.

In a similar way, each store with a clinicshould establish principles and protocolsthat define when clinics should referpatients to pharmacists. Perhaps pharmacyassociations might develop guidelinesfor this.

Handled the right way—so that pharmacistsand clinic staff offer complementaryservices and clearly understand theirrespective roles—the result could benefiteveryone.

Mr. Eckel is professor and director ofthe Office of Practice Developmentand Education at the School ofPharmacy, University of NorthCarolina at Chapel Hill.