Guest Host: Susan Page

A woman consults nurses at a RediClinic, which offers low-cost examination and treatments for minor illnesses often half the cost of a regular doctor's visit, inside of a Duane Reade drugstore October 6, 2006 in New York City.

A woman consults nurses at a RediClinic, which offers low-cost examination and treatments for minor illnesses often half the cost of a regular doctor's visit, inside of a Duane Reade drugstore October 6, 2006 in New York City.

More than six million people go to health clinics each year in retail stores like Wal-Mart and CVS. It’s a convenient place to get a strep test or vaccination on evenings and weekends when physicians are often unavailable. The out-of-pocket expenses can also be cheaper. But the American Academy of Pediatrics advises parents not to take children to these clinics. And other doctors say those with certain chronic diseases could be at risk if they rely too heavily on them for medical care. Guest host Susan Page and a panel of guests discuss the pros and cons of retail health clinics.

Guests

  • Dr. Ateev Mehrotra Associate professor of health care policy and medicine, Harvard Medical School; policy analyst, RAND Corporation
  • Dr. Nancy Gagliano Chief medical officer, CVS MinuteClinic
  • Dr. Wanda Filer President, The American Academy of Family Physicians; practicing physician in York, Pennsylvania

Transcript

  • 11:06:54

    MS. SUSAN PAGEThanks for joining us. I'm Susan Page of USA Today, sitting in for Diane Rehm. There are now almost 2,000 health clinics nationwide in retail stores, like Walgreens and Target. But some doctors warn getting medical care at these facilities could be risky for some patients. With me in the studio today to talk about retail health clinics, Dr. Wanda Filer of the American Academy of Family Physicians. Welcome.

  • 11:07:18

    DR. WANDA FILERThank you very much.

  • 11:07:19

    PAGEAnd joining us from a studio in Boston, Dr. Ateeva (sic) Mehrotra. I'm sorry. I'm sure I screwed that up. Dr. Ateev Mehrotra, thanks so much for joining us. And I - apologies for mispronouncing your name.

  • 11:07:31

    DR. ATEEV MEHROTRANo problems whatsoever. Thanks for having me.

  • 11:07:32

    PAGEHe's with the Harvard Medical School. And joining us by phone from Rhode Island, Dr. Nancy Gagliano with the CVS Minute Clinic. Welcome to you, as well.

  • 11:07:41

    DR. NANCY GAGLIANOThank you very much for having me.

  • 11:07:43

    PAGELater in this hour we're gonna take listener calls. We're interested in your comments, your experiences. Have you used these clinics yourself? We'll be taking your calls at 1-800-433-8850 and reading your emails at drshow@wamu.org. But first, joining us from a studio in Philadelphia, Jeffrey Rosen. He's president and CEO of the National Constitution Center. He's also the author of a new book, "Louis D. Brandeis: American Prophet." Jeffrey Rosen, thanks for being with us.

  • 11:20:02

    PAGEWelcome back. I'm Susan Page of USA Today sitting in for Diane Rehm. And we're going to talk about those health clinics that have popped up, 2,000 of them across the country that -- where you can go to get a shot or find out if you have strep. We're joined to talk about this with Dr. Ateev Mehrotra. He's an associate professor of health care policy and medicine at Harvard Medical School. He's also a policy analyst for the RAND Corporation. And joining us by phone from Rhode Island is Dr. Nancy Gagliano. She's the chief medical officer for CVS MinuteClinic. And with me here in the studio, Dr. Wanda Filer. She the president of The American Academy of Family Physicians. She is herself a practicing doctor in York, Penn.

  • 11:20:44

    PAGEWell, Dr. Gagliano, let's start with you. CVS estimates it has seen 30 million patients since you started opening these clinics, since 2000. What's been the experience that you've had?

  • 11:20:56

    GAGLIANOSo, thanks, once again, for having me on the show. I'm thrilled to be here and I've been with MinuteClinic for over six years now. When I started at MinuteClinic, we had about 400 clinics, and now we have over 1,135. So we're really seen enormous growth. I'm a primary care provider by training. I spent 21 years at Mass General Hospital as a PCP. And one of the things that drove me to move from Mass General to this position was the fact that we have a tremendous need for access in this country. And I firmly believe that MinuteClinic has been a great source of that access. And I think those 30 million patients you're mentioning is a testament to the fact that we have a primary care shortage and people need health care.

  • 11:21:52

    GAGLIANOAbout half of the patients who come to us don't have a PCP. The patient satisfaction scores are phenomenal. Patients really value the fact that we provide care evenings and weekends. And the care is really high quality. So I think we're doing a great service to improve access and to people who need it.

  • 11:22:15

    PAGEAnd PCP would be primary care physician, right?

  • 11:22:17

    GAGLIANOYes, I'm sorry.

  • 11:22:18

    GAGLIANOYeah, mm-hmm. That's okay.

  • 11:22:19

    GAGLIANOAbsolutely. Primary care physician.

  • 11:22:21

    PAGEDr. Mehrotra, why do you think they've been so popular?

  • 11:22:25

    MEHROTRAYou know, when we talk to patients who have visited retail clinics, I think the top three reasons are convenience, convenience and convenience. They -- you know, when we talk to patients, they'll describe, you know, I work double shifts. I don't have time to see a doctor. Or I thought about calling my doctor and they told me it was going to be a three- or four-day wait and I didn't want to wait in the waiting room for that long. This was that much more convenient. So I think that is, again, the primary driver.

  • 11:22:51

    MEHROTRAI think, to some degree, increasingly it's also the costs. And the costs are driven by, so many of Americans now have high-deductible health plans where they have to pay the first $1,500, $2,000, $2,500 out of their own pocket. And when they see the cost differential between going to a retail clinic, such as MinuteClinic, versus going to their doctor, they see some savings and, therefore, that probably attracts a good number of patients also.

  • 11:23:16

    PAGEHow much difference is there in the cost?

  • 11:23:19

    MEHROTRAIt's about, in what we've estimated, about 30 to 40 percent cheaper to go to a retail clinic than going to a doctor's office or urgent care center.

  • 11:23:28

    PAGESo, Dr. Filer, you argue that for some patients, they should be careful not to rely on these too much. What's your concern?

  • 11:23:36

    FILEROne of the concerns we have, Susan, is in this country, in family medicine and primary care, we tend to see very complex patients these days. Our patients typically have five to 10 different diagnoses. They are multiple medications. And so for the person who's generally healthy, for the person who has maybe sort of head cold symptoms or a sore throat and they just want to -- or they want to get some immunization, utilizing this retail clinic as part of our medical neighborhood, absolutely fine.

  • 11:24:06

    FILERBut the continuity of care, having a relationship with a family physician who knows you, who knows your health risks, who knows your personal goals, and also we have your records and we know, maybe, what specialty colleagues you might be seeing, that opportunity to sit down and talk with you not only for -- about your sick visit at this time, but also make sure it isn't a flare-up of some other condition that's underway. That complexity of care requires time and it requires an expertise and the relationship goes a long way to improving care for that patient.

  • 11:24:35

    PAGEWell, Dr. Gagliano, what do you think about that? Is there a risk in terms of continuity of care?

  • 11:24:40

    GAGLIANOSo I completely agree with Dr. Filer. The patients who tend to come to MinuteClinic tend to be patients who are fairly straightforward. People are really good and understand when they have a sore throat, when they need an immunization. Yes, indeed, we do see some other patients who may be more complex. And for that reason, we very , very much support the concept of the medical neighborhood. So, for example, for every patient we see, we send a summary of their visit to their primary care provider within 24 hours.

  • 11:25:22

    GAGLIANOWe also have over 70 health system affiliates across the country. And with those affiliates, we integrate our electronic medical records to make it really easy for our providers to be able to get a sense of the patient's medical history and to get those visit summaries right back to the provider. The other thing that we do is we have lists of primary care providers for each clinic, of primary care providers who are accepting new patients. So if we do see a patient, we make sure that -- we encourage them to have a PCP. Because we still firmly believe that patients benefit from having a PCP.

  • 11:26:03

    GAGLIANOAnd then the last thing I'll say is that we practice with guidelines and what I call guardrails. So if we see a patient who is too complex to our setting, we either get them back to see their PCP or to another care setting, so that somebody who is better able to take care of the patient is evaluating the patient.

  • 11:26:26

    PAGEDr. Mehrotra, I know that you were involved in a study that RAND did about whether there is continuity of care and what happens with people who use these clinics. What did you find?

  • 11:26:37

    MEHROTRASo we had, I think, a mixed picture there. So the concerns that we have heard from some primary care specialty societies as well as individual physicians is that this will disrupt the primary care physician relationship between the patient and the provider. And we saw -- we studied a bunch of patients who went to a retail clinic versus a comparable group of patients who went to a -- their primary care physician. We found that, maybe not surprisingly, at least continuity was hurt, in the sense that patients liked going to a retail clinic and they kept on going back. So they were less likely to see their primary care physician in follow up. They were less likely to, say, get an annual physical in follow up.

  • 11:27:19

    MEHROTRAOn the other hand, when we -- why does continuity matter? And a number of the concerns that have been raised by the physician community is that, well, continuity is important because that will make sure that patients get the preventive care that they need. Or if they have a chronic illness, such as diabetes, they'll make sure to get the chronic illness care that is necessary for management. And there is where we don't really find it -- where we find no difference in terms of preventive care, receipt of preventative care or chronic illness care. So, again, a mixed picture.

  • 11:27:49

    PAGEDr. Filer.

  • 11:27:51

    FILERIt's, for me, from my perspective, after 25-plus years in family medicine, I've seen the benefit of continuity of care with my patients. I also know that I've seen the data that suggests that some of our smallest practices, those one- and two-physician practices, have some of the best quality outcomes. I think for the, again, for the person who is generally healthy, who has, if you will, sort of those straightforward conditions that Dr. Gagliano mentioned, retail clinics are probably a really good option.

  • 11:28:20

    FILERBut one thing I would suggest is everyone needs a family physician. Everyone needs to have a usual source of care, somebody who knows them, who knows their medical history, who knows their family medical history, who maybe knows that, you know, their husband's drinking too much or that their work is really stressful, and they can have that broader conversation beyond that five-minute kind of visit. There's a whole -- your health requires an investment. An investment in time, an investment in a relationship. And I think that's where primary care -- around the world, the systems that give the best outcomes at the lowest costs do so on a strong backbone of primary care.

  • 11:28:57

    FILERAnd these retail clinics are part of that primary care, but they're not necessarily a replacement.

  • 11:29:02

    PAGEAnd in your own practice, do you sometimes get these alerts, these notices from MinuteClinics or other health clinics, these retail health clinics, that a patient of yours has gone there and gotten some care?

  • 11:29:14

    FILERAbsolutely. And I'm appreciative that they're there. Typically, what we'd like to do is ask our patients to call in and we'll try to work with them and figure out if we can, you know, work them into the schedule. Typically our people have an awful lot of, as I mentioned earlier, chronic disease. But we can usually find a way to, you know, sneak in that two-year-old who's got an earache and a fever and get that child seen. If there's some reason that we cannot and that patient really needs to be seen, we also may make that recommendation that, knowing you, knowing your health care, we think it's absolutely safe for you to go to a retail clinic.

  • 11:29:47

    PAGEDr. Mehrotra, have you found that this development, these new clinics that have opened have put pressure on primary care physicians to be a little more convenient themselves? You said that was the main reason people are turning to them.

  • 11:30:04

    MEHROTRARight. So I think the first point to make is that there is, I think the listeners out there will appreciate that there is a lot of frustration about going to see your physician, where, you know, you often have to wait a couple days and also that waiting room time. You know, some of the work we've described is that on average a patient is waiting about an hour in their waiting room before they see their patient -- sorry, their physician. So I think there's a frustration. And so one of the things we talked about with retail clinics is the convenience of trying to get in and out quickly.

  • 11:30:33

    MEHROTRANonetheless, you asked the question of, are primary care physicians responding to this by increasing convenience? And we hear about it anecdotally. You hear about pediatricians who are saying, oh, I'm going to have an hour in the morning and an hour in the evening where you can just walk in, so it's similar to a retail clinic. But on a national scale, I don't know to what degree that's happening.

  • 11:30:54

    PAGEWhat about you, Dr. Filer? Have you seen an impact?

  • 11:30:57

    FILERVery much so. We've seen -- we've surveyed our members in The American Academy of Family Physicians, that's almost 125,000 members. The vast majority of them have after -- have later evening hours. They have some weekend hours. They've really, I think, broadened their accessibility. That's not to say there's not a -- still a major shortage of primary care physicians in this country. And, again, as we've had a growth in the population, an aging of the population, and a real onslaught of chronic disease, the people that I am told I have 15 minutes to see typically take 30 to 45. Well, automatically, there's an hour that you're behind.

  • 11:31:33

    FILERAnd I can assure you that your family physician doesn't like being behind any more than the patient likes to wait in the waiting room. We'd like to stay on schedule. But I will give the patients the time they need when they need it. And that's one of my commitments to them.

  • 11:31:46

    PAGEI'm Susan Page and you're listening to "The Diane Rehm Show." We're taking your calls at 1-800-433-8850. Let's go to a doctor who's calling us from Cleveland. Renee, hi, you're on the air.

  • 11:31:57

    RENEEHi. I'm not a physician. I manage a physician's office. So I'm calling because our practice is very much against these clinics because -- and I'll give you an example. We've got a patient who had a UTI, a urinary tract infection, went to one of the MinuteClinics. Then called us two weeks later because they gave her a prescription for an antibiotic, called us two weeks later, she was still having the same symptoms. So I check with the doctor. He knew the patient and said, oh, she has long-standing kidney problems. Call the MinuteClinic and find out what the results of the culture and sensitivity were because there's so many antibiotic-resistant bacteria now. But you have to know that to know which antibiotic to put someone on.

  • 11:32:41

    RENEESo I call, I find out from the woman what drug store it was, call, and there's a menu. And it says, if you're a physician's office calling, call this 800 number. So I call the number and I identify who I am, why I'm calling. And as soon as I say, I want to get the results of the culture and sensitivity, the girl cuts me off and says, we don't do cultures. So there we have a patient who has kidney problems and long standing, goes to a MinuteClinic, they don't do a culture and sensitivity. She took an antibiotic which was ineffective and then we're stuck with the train wreck that results two weeks later.

  • 11:33:15

    RENEEThe other thing we've noticed is that the -- when the patients -- when we get those reports from CVS, you'll notice that the nurse practitioner will sometimes prescribe an antibiotic that she's allowed to prescribe. They go to the drug store. But also there's a column where they say, go get this nasal spray, go get this throat lozenge. So it's a self-serving system. They're directing people to purchase products in the drug store. They also have the people in the drug store, so they're going to buy other things. And so I'm just -- for those, all of those reasons, I'm really against it.

  • 11:33:48

    RENEEAnd for our practice, we sometimes stay there till 10:00, 10:30 at night during flu season. We always schedule patients. If they're sick and need to be seen, we will get them in. That's how we run our practice.

  • 11:34:01

    PAGERenee, thanks so much for your call. Well, Dr. Gagliano, you are the chief medical officer for the CVS MinuteClinics, so let me give you a chance to respond to the points Renee was making.

  • 11:34:10

    GAGLIANOThank you. And I appreciate hearing your concerns, Renee. And this incident must have been a while ago, because we do now do cultures for our patients with urinary tract infections. And before we did cultures, only very straightforward patients were seen. So clearly there was a miscommunication with the patient, if she was as complicated as you're describing for her to come to a MinuteClinic with a urinary tract infection. But I want to assure people that we do do cultures and sensitivities when clinically appropriate.

  • 11:34:50

    GAGLIANOThe other thing that I think is important to know, and Ateev might be able to review this as well, there's been some data that shows that actually the cost, the prescription costs and the total cost per case for a patient who comes to a MinuteClinic is as low, if not lower than other sites of care. So we tend to prescribe less than a typical visit. And that has been published in the annals.

  • 11:35:28

    GAGLIANOAnd I also want to reassure our listeners that there -- we call it a firewall -- there is a very, very clear firewall between MinuteClinic and the retail and pharmacy, so that there's absolutely no benefit to MinuteClinic in any way, no incentive in any way that our providers would ever prescribe for the benefit of CVS or the pharmacy. These are two -- these are run completely separately and our guidelines are 100 percent built on what is the best care for those patients.

  • 11:36:10

    PAGEAnd I think Renee was saying that it wasn't for the prescription itself, it was for suggestions on buying things that were non-prescription remedies. Does that ever happen?

  • 11:36:18

    GAGLIANOSo that's exactly -- falls into what I'm describing, that our guidelines are for both prescription and non-prescription medications for the treatment of the patient's condition. And once again, our providers have absolutely no insight into any benefit that the retail might receive. In addition to that, our providers make it very clear, both verbally as well as in our written material, that the patient should choose to get their medications and their treatments at any place of their choice.

  • 11:36:54

    PAGEDr. Nancy Gagliano, she's the chief medical officer for the CVS MinuteClinic. And we're also joined this hour by Dr. Ateev Mehrotra, an associate professor of health care policy and medicine at Harvard Medical School. And with me here in the studio, Dr. Wanda Filer, president of The American Academy of Family Physicians. We're going to take a short break. When we come back, we're going to go to the phones. We've got a couple callers who have used these clinics and had different experiences. We're going to go to them. We're going to read some of your emails. 1-800-433-8850 is our toll-free phone number. Or you can send us an email to drshow@wamu.org. Or find us on Facebook or Twitter. Stay with us.

  • 11:40:01

    PAGEWelcome back. I'm Susan Page of USA Today, sitting in for Diane Rehm. And we're talking this hour about the explosion of retail health clinics and how people use them. Let's go to Hans, calling us from Louisville, Kentucky, to talk about his experiences. Hans, welcome.

  • 11:40:15

    HANSHi, hi, thank you for having me.

  • 11:40:19

    PAGEYes, you're welcome.

  • 11:40:21

    HANSSo I was talking about, I started going to a primary care physician when I was 18 years old and came out as gay, and then he ended up being a little bit -- I guess not as accepting as others. So I was bouncing around those MinuteClinics to do a lot of things for school because I'm a student teacher, and I had -- excuse me -- because I'm a student teacher, and I had to get some physicals and things done. And actually my MinuteClinic that I ended up going to quite a bit in the meantime was actually able to connect me with a physician that's good for my needs as a gay man.

  • 11:40:57

    PAGEInteresting, Hans, thanks very much for your call. You know, Dr. Filer, you had mentioned that one of the good things about having a primary care physician is they know a lot about you. But I wonder if there are cases where that can create problems, as it did for Hans, and you might actually prefer to be going to somebody that may know you a little less well.

  • 11:41:14

    FILERWell, and certainly there is that anonymity factor that -- but I think what I hear from Hans here is the importance of him finding a relationship. The MinuteClinic people, it worked as the system as you want it to work. The MinuteClinic people, to their credit, were able to meet his needs in the short term but also connect him to someone where he now has a burgeoning relationship that's strengthening and will give him, you know, an opportunity to have whatever other conversations that he may want to have in the realm of continuity.

  • 11:41:43

    PAGEHere's an email from Sammy, who's writing us from Washington, D.C. Sammy rites, are birth control pills or other contraceptive methods available at retail health clinics? Could these clinics be another option for making basic reproductive health care more accessible and less expensive? Every time I have to refill a prescription, it is a huge inconvenience and cost to see my doctor. Dr. Gagliano, what do you think?

  • 11:42:05

    GAGLIANOHi there, so yes, it's -- contraceptive care is a service that we recently added to our list of services. And I think once again, MinuteClinic is a great place for the in-between visits, the renewal or perhaps the initiation. Still believe that a patient should have a primary care provider. Nowadays a pap smear and other screening tests aren't required so frequently that MinuteClinic is a great place for that in-between.

  • 11:42:43

    PAGEAnd you've -- you've just recently started to offer birth control prescriptions?

  • 11:42:47

    GAGLIANOYes, within the -- within the last year. That's a new service that we've provided, as well as counseling on other forms of contraception, and if another form that we're not able to deliver at MinuteClinic is needed, we can refer the patient to the appropriate provider.

  • 11:43:03

    PAGEYou know, I think sometimes teenage girls have trouble going to their pediatrician and asking for a birth control prescription. If a teenager, somebody under 18, came to a MinuteClinic, would they be able to get a birth control prescription?

  • 11:43:16

    GAGLIANONot at this time. You know, those teenage years are pretty sensitive years, and this is a time that we certainly believe that if they're sexually active, it's very appropriate for them to be working directly with a physician that they have continuity with, and then the decision and discussion of how involved to have the parents become is also part of the conversation that's important with the physician.

  • 11:43:44

    PAGESo how old do you have to be to get a birth control prescription at a MinuteClinic?

  • 11:43:48

    GAGLIANOEighteen.

  • 11:43:49

    PAGEEighteen, and this isn't a law. This is something you've chosen to follow as a policy.

  • 11:43:52

    GAGLIANOExactly. So there are laws that support prescribing contraception to younger -- younger than 18, particularly calling them mature minors or emancipated minors, depending on their situation, but we have elected that we think it's best during those years to have a relationship with a physician to handle this kind of an issue.

  • 11:44:18

    PAGEDr. Filer?

  • 11:44:19

    FILERFamily medicine does a lot of pediatric care in this country, and I have patients that I've taken care of from the time they've been newborns all the way up now into several decades of their lives, I have to admit. One of the things we do, we frequently have the conversation, but we also start that conversation when they're 12, and they're 13, and we do what we call anticipatory guidance. And you'll have a conversation, sometimes with the parent in the room.

  • 11:44:42

    FILERBut once that child comes to you, and she's 15, and she said I'm interested in birth control, we can go through the options with her. One of the recommendations nowadays for that age group is something called LARK, long-acting reversible contraception, which is actually placed in the upper arm, and that's something that many family physician, OB/GYN offices will do.

  • 11:45:02

    FILERWe also do a lot of adolescent health care. So this -- I would agree completely with Dr. Gagliano, this conversation about contraception often goes beyond contraception. It goes to self-esteem, it goes to dating violence, it goes to substance abuse issues, and there are much broader conversations to have to make sure that that younger patient is on the path that will give them optimal health.

  • 11:45:23

    PAGEDr. Mehrotra, the American Academy of Pediatrics two years ago actually advised parents not to bring their kids to these clinics. What was the reasoning?

  • 11:45:34

    MEHROTRAYeah, what we hear from in particularly the AAP, the American Academy of Pediatrics, but others is the apprehension regarding the quality of care that's being provided at these clinics, and as we've already discussed, the issues regarding is this going to disrupt coordination of care and continuity of care with their physicians. And so that's been the primary driver for that and has motivated some of our research on those topics.

  • 11:45:58

    PAGEDr. Filer, what do you think?

  • 11:46:00

    FILERWe typically say, when you look at pediatric patients, that children are not just little adults. They require a different approach frequently, they have different possible conditions that avail themselves. And so there is a -- you know, again, in family medicine we do a lot of pediatrics, but they are not little adults. They need a special way to be handled. I do know that a lot of -- a lot of times if we -- any patient of any age will say if you happen to go to a retail clinic and, you know, 24 hours later things are worse, or they're not any better, give us a call because maybe we need to see you and follow up.

  • 11:46:36

    PAGESo Dr. Filer, have you or any member of your family ever used one of these clinics?

  • 11:46:40

    FILEROh, my family, my daughters, gee, I have to think about that. I do not think they have, but I know my husband and I have not.

  • 11:46:47

    PAGEHow about you, Dr. Mehrotra, has anybody in your -- anybody in your family used one of these clinics?

  • 11:46:51

    MEHROTRAYes, my father and my wife.

  • 11:46:54

    PAGEAnd what did they -- what did they use them for, not to be too personal?

  • 11:46:58

    MEHROTRAYou know, issues of -- one was a concern about sinusitis and whether antibiotics were necessary. It's also a great place when you need a flu shot, and you want to get someplace that's convenient. So they're both treating a new problem, as well as getting preventive care.

  • 11:47:14

    PAGESo you're a famous doctor. Why didn't they just come to you?

  • 11:47:16

    MEHROTRAWell, we try to, at least in medicine, try to not treat our family members. It's kind of a place where we -- I'm not sure we're the most -- it's the most appropriate way to provide care. So sometimes it's better to have somebody else involved.

  • 11:47:28

    PAGEDid you think they got pretty good care there?

  • 11:47:31

    MEHROTRAYeah, no, I think the work -- you know, the advantages that we've seen, so both say anecdotal experience, as well as our research. So on the anecdotal experience, and I think this, Nancy mentioned this also, is that often the patient satisfaction or patient experience is quite good because, one, you get in pretty quickly, two, they take a little bit longer time with you, and so the convenience is really attractive.

  • 11:47:53

    MEHROTRAAnd then on the quality side, you know, there have been these concerns, but as was mentioned earlier, when we've looked at quality of care at retail clinics versus primary care physician offices, we see an antibiotic prescribing rate that's very similar and in some cases actually superior in the sense that we find that retail clinics are less likely to prescribe broad-spectrum antibiotics, and those are of particular concern, given issues of resistance.

  • 11:48:20

    MEHROTRASo I think overall, from both the anecdotal and our research, overall the results on the quality side are reassuring.

  • 11:48:25

    PAGEAnd Dr. Gagliano, how about you? Have you used these clinics yourself?

  • 11:48:31

    GAGLIANOI personally haven't, but certainly my family members have.

  • 11:48:37

    PAGEAnd how have they used it, if that's not too personal?

  • 11:48:39

    GAGLIANOSure, so one example is my son who is now in his early 20s needed a PPT placed for a job, where he needed to be cleared from a perspective of tuberculosis. My daughter used it for an ear infection. There's all sorts of, you know, reasons to use retail health in this sort of way, and as I think you're getting a little bit of a flavor, whether it's to get your blood pressure checked or something that's quick and straightforward, MinuteClinic is very, very convenient. And as Ateev mentioned, the quality is very, very solid, and there's been good research on demonstrating that the quality of care is very good.

  • 11:49:30

    PAGEWe've got several callers who've said they have used these kind of clinics themselves. Let's talk their experiences. Let's go first to Fasil, calling us from Tampa, Florida. Thank you for joining us.

  • 11:49:44

    FASILThank you for giving me a chance to call. Thank you for taking my call. Yeah, I had a very bad experience. I just want to let your panel know that I had a problem about six, seven months back in my eye infection, and I went to a MinuteClinic. And there was a person there, she called herself a physician, but I find out she was not. And she writes me a wrong prescription for my eyes, and I went through a big pain with it for four or five days, and then my -- I went to -- I called them three times. They say I cannot do anything, you go to your ER or go to your physician.

  • 11:50:18

    FASILAnd then I went to my physician, and they told me oh, there was a wrong, you know, the prescriptions here, I needed some kind of drop, and then he told me just go and wash your eyes with the cotton, and I did for three days, and my eye was okay. But I went through a lot of pain after the prescription she writes me, and...

  • 11:50:34

    PAGEI'm glad that it -- I'm glad it finally worked out. What about the question about follow-up, Dr. Gagliano. Are there -- if somebody's having a bad experience at these clinics, what can they do?

  • 11:50:43

    GAGLIANOThanks for asking. Well first of all, I too am sorry to hear that the eye condition sounds like it continued, and it progressed, and I do think that sometimes patients may mishear the provider's description of themselves because we have both nurse practitioners and physician assistants in our clinics, and that might have caused the confusion of who was the provider.

  • 11:51:16

    GAGLIANOWe have a couple of things. For patients when we believe their condition is worrisome or not straightforward, we will often call the patient back at the 48 to 72 hours to see how they're doing and then to refer them on to additional care after that. We have a call center that is available, and clinical calls are then transferred to typically our provider managers to talk to the patients and help them get to the appropriate level of care.

  • 11:51:52

    GAGLIANOIt is common that if, you know, people's conditions, no matter where they are seen, often worsen, and that is part of health care and part of life. So helping a patient get onto an additional place of care, if the MinuteClinic visit did not solve the problem, it certainly is an indication that more expertise was probably needed in determining what was the next step.

  • 11:52:19

    PAGEI'm Susan Page, and you're listening to the Diane Rehm Show. You know, one of the things that we sometimes hear is that these clinics are giving access to health care with people who don't have a doctor, or maybe there's a shortage of doctors in their community. Dr. Mehrotra, I know that you've looked at this. Do these clinics tend to come up in places that do have a shortage of physicians?

  • 11:52:44

    MEHROTRARight, so what -- you know, there's been this idea that has been raised that oh, what will -- what retail clinics can really do is fit the hole we have in our society in the sense that we have many communities in which there are not enough physicians. They're called primary care physician shortage areas. And the hope has been -- was expressed that maybe retail clinics can, again, fill that gap. In some of the research we've done and others have done, we don't find that's the case. We find that retail clinics are just as equally likely to be in the -- are not more likely to be in those shortage areas.

  • 11:53:17

    MEHROTRAAnd so you can look at that two ways. One, you can say, well, they're not meeting those patient -- going to the cities or communities where people need the care the most. On the other hand, you could flip that around and saying they're going exactly where the physicians are, who are also not in those same communities.

  • 11:53:35

    PAGEHere's a tweet we -- yes, Dr. Filer.

  • 11:53:36

    FILERThe bottom line is we need more primary care physicians, and we've got lots of ways we can accomplish that.

  • 11:53:42

    PAGEHere's a tweet from a listener, who writes, please speak to the potential of retail health clinics to bring clinical trials closer and make them more convenient to participants. Dr. Gagliano, is that something that you all have tried to do?

  • 11:53:56

    GAGLIANOSo there have been a few studies that we have been involved in, bringing the research right into the community for -- one study I'm thinking of right off the bat has been around helping smoking cessation and looking at different ways that incentives can help patients quit cigarettes, and we were involved in that study with the University of Pennsylvania not too long ago. So it is an opportunity for us, and, you know, Ateev and I have chatted over the years, and one of the nice things about our relationship with multiple health systems across the country is that there are opportunities such as that.

  • 11:54:36

    PAGEDr. Mehrotra, what do you think the possibilities are? What could be done?

  • 11:54:40

    MEHROTRAIn terms of getting people into clinical trials?

  • 11:54:42

    PAGERight, using these health clinics in ways for research or for clinical trials.

  • 11:54:51

    MEHROTRAYou know, so the first point is that I do think that there's a great opportunity there, that in the sense that because the retail clinics are seeing so many patients per year over such a geographic span that for trials on the topics of -- you know, for conditions they manage frequently, sinusitis, urinary tract infections, there's a lot of potential. I think there's mixed feelings among the American public about clinical trials. Some are excited about entering those trials, and others are very nervous about it. So I think that's something that's going to have to be considered. But I do think there's an opportunity.

  • 11:55:23

    PAGEWhat do you think, Dr. Filer? You're shaking your head.

  • 11:55:24

    FILERI'm shaking my head because when I think clinical trials, I think cancer treatment, new, cutting-edge treatments, and clearly you need someone who's got your whole picture in sight, and you've got your whole medical history, also will coordinate that care with your oncologist, with your cardiologist, whomever that might be. And that is in my mind very much -- this is different than doing a study around sinusitis. Clinical trials, like clinicaltrials.gov, these are cutting-edge research, and I have a lot of patients who have done that, but it requires explanation, coordination of care, and sometimes the patients -- being their interpreter.

  • 11:56:00

    PAGESo give our listeners some advice, Dr. Filer. When should they think I can go down to this corner clinic, and it's going to take care of me?

  • 11:56:07

    FILERIf you have a family physician, I would suggest you call them first and find -- and explain what your symptoms are. And then we can look at your medical record and say, yes, that corner clinic's fine, if for some reason we can't get you in, and we will try to get you in. If you don't have a family physician, I would encourage you, if you have had symptoms, you know, maybe it's a little bit of a head cold symptom, or you're generally a well person, or maybe you've got that need for a flu shot or some other kind of short-term, one-off sort of piece, then it's okay.

  • 11:56:36

    FILERBut if you're having chest pain, if you're having a symptom that's been going on for several weeks, if you've got a family history that's a little bit worrisome, or you've got other underlying medical conditions, I would encourage you to go to a primary care physician.

  • 11:56:49

    PAGEMr. Mehrotra, what would you say? What's your advice to our listeners?

  • 11:56:53

    MEHROTRAYou know, I think I would echo largely what Dr. Filer said, that, you know, these are a great opportunity for patients who have simple problems, immunizations, PPDs as was described before, or worries about you have sinusitis, a great option for patients, and that's what I really encourage patients to go there for.

  • 11:57:14

    PAGEAll right, Dr. Mehrotra, Dr. Filer, Dr. Gagliano, thanks so much for joining us on this hour of the Diane Rehm Show.

  • 11:57:20

    GAGLIANOThank you for having us.

  • 11:57:20

    FILERThank you.

  • 11:57:22

    MEHROTRAThank you.

  • 11:57:23

    PAGEI'm Susan Page of USA Today, sitting in for Diane Rehm. Thanks for listening.

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