Study: Older patients, preventive services on rise at retail health clinics


NEW YORK — Retail-based health clinics are attracting more older patients and delivering more preventive care, particularly flu shots and other vaccinations, according to a new study from the Rand Corp.

Researchers found that visits to retail medical clinics increased four-fold from 2007 to 2009, with the proportion of patients older than 65 years old growing from 8% to 19% of all visits during this period.

More than 44% of visits to the clinics occurred on the weekend or other hours when physician offices typically are closed, suggesting retail clinics meet a need for convenient care, according to the study published online as a "Web first" by the journal Health Affairs.

"Retail medical clinics continue to grow rapidly and attract new segments of users," said lead author Ateev Mehrotra, an associate professor at the University of Pittsburgh School of Medicine and a researcher at Rand, a nonprofit research organization. "They remain just a small part of outpatient medical care, but appear to have tapped into patients' needs."

While retail clinics have begun promoting such new services as caring for chronic illnesses, such as diabetes, researchers stated that it remains uncertain whether demand for the clinics will continue to grow as the federal Patient Protection and Affordable Care Act is enacted.

"If demand for primary medical care drives longer wait times to see a doctor as it has following healthcare reform in Massachusetts, then this could drive greater demand for convenient alternatives, such as retail clinics," Mehrotra stated.

Researchers examined the latest trends in the use of retail medical clinics by analyzing information from 2007 through 2009 obtained from the three largest retail clinic operators, which account for 81% of the clinics operated nationally. Trends in usage were compared with earlier findings from 2000 to 2006.

Visits to retail clinics reached 5.97 million in 2009, up from 1.48 million in 2007. Visits to retail medical clinics for vaccinations increased sharply from 2007 to 2009, researchers found. Another recent study published by Rand researchers found that vaccination visits to the three major retail clinic chains quadrupled to more than 1.9 million in 2009. Most of the inoculations given were for influenza.

"The number of vaccinations provided at retail clinics could grow even larger if providers started counseling patients about the need for inoculations when they visit the clinics for other care," added Lori Uscher-Pines, an associate policy researcher at Rand.

In the latest study, researchers found that the proportion of retail clinics visits made for acute medical problems dropped from 78% to 51%. There was a corresponding increase in visits for preventive care, making up more than 47% of visits by 2009. The study does not capture the impact of a push made by retail medical clinic operators beginning in 2010 to increase the services offered for chronic illnesses.

The proportion of patients who reported that they did not have a primary care physician remained at more than 60%, although researchers had expected the number to drop as use of the clinics increased. Researchers stated it is possible that patients with no or weak relationships with a primary care physician are more likely to seek care at a retail clinic than patients with strong relationships with a physician.

Support for the studies was provided by the California HealthCare Foundation, a nonprofit philanthropy based in Oakland, Calif. Other authors of the studies are Judith Lave, Katherine Harris and Rachel Burns.

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