Study: Evidence mixed on clinic disruption of doctor-patient relationships

NEW YORK — A new Rand study examining the impact of retail medical clinics on the receipt of primary medical care found mixed evidence about whether the clinics may disrupt doctor-patient relationships. And, while the study found that people who visit retail medical clinics may be less likely to return to a primary care physician for future illnesses and have less continuity of care, one could argue that the study is fairly irresponsible and myopic in scope as it overlooks the physician shortage in this country and ignores the fact that clinics connect patients without a medical home back into the healthcare system.

The findings, published online by the Journal of General Internal Medicine, are the first to provide insight about how the growing number of retail medical clinics may affect doctor-patient relationships and use of primary care services, according to the authors of the study.

"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," stated senior author 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."

The study, however, did not find evidence that retail medical clinics disrupted preventive medical care or management of diabetes — two important measures of quality 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 tenfold 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 nurse practitioners and offer basic types of health care with clearly posted prices.

According to the study, 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 1-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, however, 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 primary care," stated study author Rachel 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 retail clinics on preventive care or continuity of medical care."

What the study didn’t mention is the critical physician shortage facing the nation. It is estimated that the primary care shortage will reach about 60,000 by 2015. As mentioned earlier, the study also fails to address the fact that clinics — some of which have clinical affiliations with healthcare systems — connect patients without a medical home back into the healthcare system.

Support for the study was provided by the Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization Initiative.

Comments

Ms. Alexander's critique is

Ms. Alexander's critique is quite appropriate, but more can be added.

The greater disruption of continuity of care may be placed at the hands of:

* employers and insurers, who change health plans and panels of providers every few years;
* a traditional medical community that still believes all healthcare is local, despite the fact that people move every few years; and
* the fact that the majority of physicians still practice in groups of three or less.

Ron Hammerle
Chairman and CEO
Health Resources, Ltd.
Tampa, Florida

What direction is preventive

What direction is preventive care utilization heading? http://www.healthcaretownhall.com/?p=5596