Retail health clinics have a place in the healthcare framework, especially for acute, uncomplicated medical conditions, but should not be used as a stand-in for physician-patient relationships that are the foundation of primary care, said a statement from the American College of Physicians (ACP).
The paper, which focused on retail clinics within pharmacies or retail stores, addressed the expansions in scope of practice from acute care for minor conditions to management of chronic diseases, and called for research into the potential negative outcomes of this recent shift, Hilary Daniel, BS, and Shari Erickson, BA, MPH, of the ACP's Medical Practice and Quality Committee, wrote in the .
The lack of relationship-building in the retail clinic model could create a gap where opportunities for identifying other medical issues will likely be lost, and antibiotics will likely be overprescribed, Daniel and Erickson wrote.
The appropriate role for retail clinics should be an "episodic alternative to care...for relatively healthy patients without complex medical histories," they indicated, and in no way should take the place of established long-term patient-physician relationships.
"A balance must be struck between the convenience and access retail clinics provide and the importance of longitudinal relationships between patients and physicians, particularly for patients who have complex medical histories," the paper stated.
Retail clinics should have a structured referral system to encourage patients to establish care with a primary care physician and/or to follow-up with them after a visit. At the same time, retail clinics should not refer patients directly to subspecialists without a primary care consultation, the committee asserted.
The ACP's policy encouraged physicians to address appropriate use of retail clinics with their patients, and also to develop strategies to improve access to flexible scheduling and after-hours care in their own practices.
Scope of practice limits for retail clinics must take into account the limited physical space and infrastructure available, the ACP statement indicated, and patients should be informed of those limits either before or during the visit.
Information from retail clinic visits -- including but not limited to the administration of any vaccines, prescriptions, tests, or post-care instruction -- should be promptly shared with the primary care physician, the committee wrote.
The policy paper also repeatedly mentioned the need for more research to address chronic and complex disease management in retail clinic settings.
Disclosures
None of the authors reported any relevant financial conflicts of interest.
Primary Source
Annals of Internal Medicine
Daniel H, et al "Retail health clinics: executive summary of a polity position paper from the american college of physicians" Ann Intern Med 2015; DOI: 10.7326/M15-0571.