Evidence mixed on whether retail clinics disrupt doctor-patient relationships

A new RAND Corporation study examining the impact of retail medical clinics on the receipt of primary medical care finds mixed evidence about whether the clinics may disrupt doctor-patient relationships.

The study found that people who visit retail medical clinics are less likely to return to a primary care physician for future illnesses and have less continuity of care. However, there was no evidence retail medical clinics disrupted preventive or management of diabetes, two important measures of quality of primary care.

The findings, published online by the , are the first to provide insight about how the growing number of retail may affect doctor-patient relationships and use of primary care services.

"There is concern whether retail clinics may disrupt the relationship between patients and their personal physicians, which may make it difficult to maintain the quality and continuity of medical care," said senior author Dr. Ateev Mehrotra, an associate professor at the University of Pittsburgh School of Medicine and a researcher at RAND, a nonprofit research organization. "We found use of retail clinics did have a negative impact on some aspects of primary care."

RAND researchers have documented the rapid rise of retail clinics, which now number more than 1,300 nationally. Use of the clinics increased 10-fold from 2007 to 2009 among those with commercial health insurance, with use projected to rise more in the future. The walk-in clinics typically are staffed by and offer basic types of health care with clearly posted prices.

Researchers examined the link between retail clinics and use of primary care providers by examining the records of a large group of people with commercial health insurance who used a retail medical clinic for an acute medical condition during 2008. Researchers examined their medical care a year before the visit and a year afterward, comparing their patterns of care with those patients who visited a primary care physician for an acute health problem during the same period.

People who visited a retail medical clinic for one of 11 common ailments such as a respiratory infection or urinary tract infection were less likely over the next 12 months to visit a primary care physician the next time they needed similar care. Patients who visited retail clinics also had less continuity of care, such as seeing the same physician for their medical needs.

Mehrotra said since the use of retail clinics was not associated with less preventive care or poorer management of diabetes, it's hard to make an overall assessment about the impact that the use of retail clinics had on the quality primary care.

"The interpretation of our findings depends on one's view about the relative importance of different aspects of ," said study author Rachel O. Reid of the University of Pittsburgh School of Medicine. "Retail clinics are still in their infancy and over time we may or may not observe a more negative impact of on preventive care or continuity of medical care."

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