Changing times change retail clinic roles

6/29/2009

NEW YORK —Questions on whether acetaminophen is safe or not. Concerns over the H1N1 influenza pandemic. Uncertainty around the safety and efficacy of pediatric cough-cold medicines. Add to that list increasing anxiety over healthcare costs in a recession economy and you have a not-near-comprehensive list of issues nurse practitioners and physician assistants practicing in a retail clinic setting face on a daily basis.

All of this means NPs and PAs are quickly joining their pharmacist cousins as the most-accessible healthcare professionals with whom consumers can consult.

According to several retail clinic senior executives, their nurse practitioners are advising consumers around the use of over-the-counter medications, when appropriate, in more than half of their patient visits. “It’s probably 75% of the time or more,” Sandra Ryan, Take Care Clinic chief nurse practitioner officer, told Drug Store News. “The nurse practitioners are really great about going out into the store, looking at what products are available, looking at the combination products to see what’s in there [and] talking with the pharmacist so that they can gain a better understanding around [OTCs].”

“Normally [that OTC discussion] is part of the treatment protocol,” Lori Knowles, RediClinic COO, noted. “We make sure our patients are educated thoroughly,” she said, arming those patients with directions in writing or appropriate dosing charts before they leave the clinic.

Most of those OTC discussions occur around the acute conditions that clinics are designed to treat—making skin rashes, cough-cold and allergy, and pain relief three of the most discussed categories. “[Nurse practitioners] are always trying to educate patients around over-the-counter products in their total assessment of the patient and whether or not they need something over the counter,” Ryan said. “As a nurse practitioner working in [a retail] setting, not only do you need to understand the [OTC] product, but you need to look at the components, the Drug Facts, and then relate that back to the age of your patient, whether it’s an elderly person or a child. Being in a retail setting and having a pharmacist colleague right there is incredibly powerful from a patient safety perspective.”

“One of the ways to assist people in their wise self-management of their illnesses…is to help them to remember to follow the labeling instructions,” Trish Hughes, VP clinical quality with MinuteClinic, added.

Another popular OTC category included in NP-patient discussions is pediatric ear care—addressing self-care solutions around remedying an ear infection during the 48 hours to 72 hours before a practitioner will prescribe an antibiotic. “We track and trend a lot of measures to make sure that we are being very appropriate in our prescribing of antibiotics,” Ryan said.

But NPs and PAs are speaking to patients around the use of nonprescription medicines more often than just during a patient visit. In fact, whenever concerns over the use of OTC medicines become topical, patients seek out NPs and PAs for answers. “By and large, we have a savvy group of customers,” Hughes said. “Anything that hits the Internet and is talked about, they’re aware.”

Concerns over the economy may be increasing consumer interest in OTC solutions as well, the retail executives noted. “We actually are hearing some of that in many locations,” Knowles said. “We are very careful to prescribe [for our patients] the most low-cost, appropriate [solutions],” she added.

“People are very cost-conscious about the cost of health care, and we do have a large percentage of patients who don’t have insurance,” Ryan said. That being the case, NPs have always been price sensitive, be it an appropriate OTC solution or a generic equivalent to a prescription remedy. “Historically for us, 30% of the patients do not have insurance,” Ryan noted, “so [nurse practitioners] have always done a great job in giving the right recommendations to patients.”

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