For Patients at Walk-In Health Clinics, Convenience Is the Key

Even though I had stopped byour local walk-in clinic to conductmy own interview and geta sense of the operation, I was the onewho got the first question: "Have youhad your flu shot?"

Family Nurse Practitioner Amy Luster,RN, APN-C, of the MinuteClinic at CVSPharmacy in Plainsboro, New Jersey,told me that patients seeking flu shotsand strep tests are the ones she andher colleagues see most often this timeof year. Not surprisingly, patients withconditions like sinusitis, bronchitis, andconjunctivitis also are frequent clinicvisitors during the winter months.

In the spring, allergies are a commoncomplaint; the end of summer is a timewhen teenagers heading off to collegevisit the clinic for their meningitis vaccinations."It is a lot faster than doctors'offices," noted Luster. "Once they havetried us, they do come back."

One reason patients are turning toclinics, explained Kathleen Caridi, RN,APN-C, manager of MinuteClinic's operationsin central New Jersey, is the convenience.Because walk-in clinics areopen 7 days and weeknights for patientswithout an appointment, they offer analternative to often crowded physicians'waiting rooms or costly emergencydepartment visits during off-hours.

MinuteClinic health care centers arestaffed by board-certified family nursepractitioners and physician assistantswho are trained to diagnose, treat, andprescribe medication when it is partof a treatment plan for common familyillnesses. Though patients are notrequired to fill their prescriptions at thepharmacy, they often do, noted Luster—for the convenience.

A Full Menu of Services

The services offered by MinuteCliniccover everything from common illnesseslike ear infections, to vaccinations,wellness programs, and campphysicals (Table). Currently, more than550 MinuteClinics are operating in27 states. Since its inception in 2000,MinuteClinic reports more than 2 millionpatient visits.

"We're always looking for more services,"noted Caridi. She and Lusterpointed out the many prevention andscreening programs also offered at theclinics. Through a promotion last May,for example, patients could get freecholesterol, blood pressure, or glucosescreenings.

"This starts the discussion," saidLuster. "Then we can sit down withthe patients, discuss what the readingsmean, and also give them informationalmaterials." Smoking cessation counselingis another popular service the clinicoffers.

Individuals with illnesses outsideMinuteClinic's scope of services, or whoexhibit signs of a chronic condition, arereferred to their physician or, if critical,to the nearest urgent care center oremergency department.

Complementing a Physician's Care

When patients arrive at the MinuteClinic, they sign in at a touch-screenkiosk, answering the typical questionsone might receive at the doctor's office,before being ushered into a privateexam room. This sets up a record forfuture visits, when visitors will onlyneed to enter their name and birth dateto sign in. Most patients simply pay theoffice visit copay indicated on theirhealth insurance card. Treatment pricesare posted at the clinics as well, forpatients paying by cash or credit. Mosttreatments at MinuteClinic cost $59.

MinuteClinic staff use a software programthat, at the conclusion of eachvisit, generates educational material,an invoice, and a prescription (whenclinically appropriate) for the patient, aswell as a diagnostic record that is automaticallysent to the patient's primarycare provider. If a patient does not havea "medical home," a list of physicians inthe area is provided.

"We encourage all of our patients tohave a medical home," said Caridi. "Wesend the record of their visit to theirprimary care doctors. This is especiallyhelpful for keeping track of children'simmunization records."

Every MinuteClinic patient assessmentand treatment follows nationallyestablished clinical practice guidelinesfrom the American Academy of FamilyPhysicians, the American Academy ofPediatrics, and the Institute for ClinicalSystems Improvement. These guidelinesare embedded in the clinic's electronicmedical records system. MinuteClinicalso has received accreditation from theJoint Commission on Accreditation ofHealthcare Organizations.

Outreach, Too

Table

CVS MinuteClinic Services^a

Common Illnesses

Allergies

Bladder infections

Bronchitis

Ear infections

Pink eye and styes

Sinus infections

Strep throat

Swimmer's ear

Skin Conditions

Athlete's foot

Cold sores

Deer tick bites

Impetigo

Minor burns

Minor skin infections and rashes

Minor sunburn

Poison ivy

Ringworm

Shingles treatment

Wart removal

Vaccines

DTaP, Td, Tdap (diphtheria, tetanus, pertussis)

Flu (seasonal)

Hepatitis A and B

Meningitis

MMR (measles, mumps, rubella)

Pneumonia

Polio

Wellness & Prevention

Camp physicals

Health screening:

Cholesterol

Diabetes

Hypertension

Obesity

Smoking cessation

Additional Services

Ear wax removal

Flu diagnosis

Mononucleosis

Pregnancy testing

Suture removal

^a Provision of some services is restricted tocertain age groups.

Caridi said that one of the most excitingaspects of the clinic model is how it hashelped to forge partnerships betweenclinic staff and pharmacists. "It hashelped to join the professions togetherin a way that helps patients," she said.

She teams up periodically with CVSpharmacists to go out into the communityto places like senior centers, tolet area residents know about the manyservices the pharmacy provides, suchas free home delivery, as well as theMinuteClinic. They end their talks witha question-and-answer period, whenpatients often ask about their medications.This outreach, said Caridi, "helpsto bring health care back to the community."

Caring Professionals—When You Need Them

While I was on-site, the business was,indeed, mostly flu shots. CVS recentlyreported that it surpassed its goal ofdelivering 1 million flu vaccinations duringthis fall's flu shot season.

Staff at the Plainsboro MinuteClinicexplained that new regulations in NewJersey—requiring flu shots for all childrenaged 18 months to 4 years 9 monthswho attend day care or preschool—have upped the number of flu shotsrequested. The regulations took effectJanuary 1, and MinuteClinic circulatedflyers on the new state requirement thisfall to help keep families informed.

One woman, waiting for her prescriptionto be filled, came by and askedabout preservative-free vaccinations,which the clinic had in stock. She gother flu shot and decided to bring her4-year-old son, who, like many children'has anxiety about doctor visits, back tothe clinic for his flu vaccination the nexttime they go out shopping.

As I departed, Caridi summed it all upwhile she was busy answering questionsand assisting another patient with thecheck-in process at the kiosk: "We arehere for the convenience."