Child Health Care at Retail Clinics

Pediatric health care in the retail clinic setting has been a hot-button issue since the walk-in clinic first entered into big-box stores and pharmacy retailers in the early 2000s. Retail clinics are staffed by nonpediatric nurse practitioners or physician assistants and generally do not serve patients younger than 18 months; in some instances, they will not treat patients younger than 2 years. However, with pediatric health care at retail clinics on the rise, the American Academy of Pediatrics (AAP) is offering help to doctors contending with clinics that are breaking up their business.

There are several schools of thought regarding the caliber of health care at retail clinics, with pediatricians voicing concerns about the continuity and quality of care. The AAP issued a statement in 2006, coming out in opposition to pediatric care at retail clinics, calling the facilities an inappropriate “source for infants, children, and adolescents.” The AAP advocates the “medical home model” in which the pediatrician and child’s family share responsibility in providing complete and stable primary care.¹ According to the AAP, offering pediatric health care in retail clinics goes against this standard. The physicianmembers assert that retail clinics cause fragmentation between a pediatrician and his or her patients because continuity of care is vital in creating a comprehensive medical history. When parents bring their children to retail clinics for minor health concerns, there may be a lack of complete follow-up and communication with their pediatrician, the AAP statement declared.²

The concern about fragmented care is not unfounded. Parents who use a retail clinic are more likely to tell their pediatrician about the visit only if the clinic advised them to do so, according to the results of a 2013 study published in the Journal of the American Medical Association (JAMA) Pediatrics. Despite having a pediatrician, 23% of parents use retail clinics for pediatric care, only 42% of whom informed their pediatrician about the visit.³

The JAMA study questioned nearly 1500 parents at 19 pediatric practices in the Midwest. A quarter of those surveyed cited “convenience” as the most common explanation for bringing their child to a clinic instead of the pediatrician. By convenience, the parents mean better hours and availability, as retail clinics allow walkins and have weekend and extended hours.

Although 15% of the parents who used a retail clinic said they did not want to bother their pediatrician after hours, 47% went to a retail clinic with their children during normal business hours, the study results showed.⁴ This result indicates that parents are either unaware of their doctor’s accessibility or are choosing pediatric care at the retail clinic over going to their pediatrician. Convenience and reduced cost have become bigger priorities for families than continuation of care, and many pediatricians have stated that it is up to them to prove that consistency is linked to superior health protection.² The AAP concurs.

With the proliferation of retail clinics in the past decade, the AAP amended its initial statement about retail clinics in 2014. The organization still disagrees with retail clinics as an acceptable setting for pediatric health care, but offered guidelines for pediatricians who find themselves competing with retail clinics. The guidelines recommend that pediatricians expand their office hours and work collaboratively with retail clinics.³

The possibility of decreased quality of care is another major concern for the AAP, although quality of care at retail clinics has been shown to be comparable to, or better than, the emergency department or doctor’s office.⁵ Almost 95% of parents who have a pediatrician were pleased with the quality of care their child received at the retail clinic, according to the JAMA survey results.³

Although not mentioned by the AAP, some critics of pediatric care at retail clinics are worried about nurse practitioners overprescribing antibiotics in an effort to boost pharmacy sales. Overprescribing antibiotics in pediatric medicine has been a topic of contention in the medical field for years, but has decreased in the past decade.⁶

Upper respiratory infections are the primary reason children seek treatment at retail clinics, and 75% of all antibiotics prescribed to children are for common respiratory illnesses, 23% of which are not symptomatic for antibiotics.⁷ According to the results of the JAMA survey, 67% of the children were prescribed antibiotics for upper respiratory infections at the retail clinic and about 29% who tested negative for a throat swab were prescribed an antibiotic anyway.³ These findings are inflated according to Ateev Mehrotra, MD, MPH, an associate professor at Harvard Medical School and an authority on retail clinic research, who found that antibiotic dispensation was actually more appropriate at retail clinics compared with other settings.⁸

No one can dispute that pediatric care at retail clinics is not going away despite the AAP’s and other pediatricians’ criticisms. The ease of use and transparent cost are persuading parents to drive to the clinic instead of the pediatrician’s office, and the pediatric health care market is working on adjusting to this change, for better or worse.

Katrina Rossos is a freelance writer from New Jersey. She graduated from Tulane University with a bachelor of arts degree in english and a concentration in biology. A previous editor for AOL, her work has been published in New Jersey Life Magazine, Nature World News, Petcha, Azula, and The Dodo.

References

• Retail-Based Clinic Policy Work Group, AAP. AAP principles concerning retail-based clinics. Pediatrics. 2006;118(6):2561-2562.
• Retail-Based Clinic Policy Work Group, AAP. AAP principles concerning retail-based clinics. Pediatrics. 2014;133(3):794-797.
• Garbutt JM, Mandrell KM, Allen M, et al. Parents’ experiences with pediatric care at retail clinics. JAMA Pediatrics. 2013;167(9):845-850.
• Berman S. Continuity, the medical home, and retail-based clinics. Pediatrics. 2007;120(5):1123-1125.
• Mehrotra A, Liu H, Adams JL, et al. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Ann Intern Med. 2009;151(5):321-328.
• Vaz LE, Kleinman KP, Raebel MA, et al. Recent trends in outpatient antibiotic use in children. Pediatrics. 2014;133(3): 375-385. doi: 10.1542/peds.2013-2903.
• Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics. 2011;128(6):1053-1061. doi: 10.1542/peds.2011-1337.
• Mehrotra A, Reducing unnecessary antibiotics prescribed to children: what next? Pediatrics. 2014;133(3):533-534. doi: 10.1542/peds.2013-4016.