Just a couple months ago, I was in the heart of New Orleans surrounded by over 2,500 forward-thinking health services researchers at AcademyHealth’s Annual Research Meeting (ARM). As a student, I try to be the fly-on-the-wall soaking in information as I explore the breadth of topics health services research has to offer while not disrupting the natural exchange of ideas and questions. However, this year was different. I came to the conference with something to share. While I didn’t present a poster or sit on a panel, I had made a recent discovery deserving of the attention of ARM attendees – particularly policy makers, health economists, and insurers.
As a finalist in an AcademyHealth student competition, which asked students to use data from the Health Services Research Projects in Progress (HSRProj) database to identify topics on which there seems to be insufficient research or funding, I discovered a gap in retail health research.
Since 2000, retail health clinics have spread across the country in pharmacies and grocery stores offering low acuity services, like vaccinations and strep testing, with same day appointments. Often staffed by nurse practitioners or physician assistants, retail clinics occupy over 2,000 locations nationwide with 10.5 million visits per year. While their reputation has undergone scrutiny from physician groups including the American College of Physicians, their resilience has led researchers to examine their effect on quality and cost.
Despite concerns from physician organizations about care quality, retail clinics have been found to provide care equal to or better than the quality observed in physician offices and emergency departments at a reduced price (per visit) and have shown better adherence to clinical guidelines. As for costs, the findings are mixed. One study found retail clinic usage increases overall health care spending for insured patients, as detailed in this previous blog post. Other studies found cost reductions and estimated large cost savings.
While the impact of retail clinic services on health care spending remains uncertain for low acuity services, retail clinics have begun providing services for higher acuity conditions. Over the past couple years; many retail clinics have formed affiliations with local health care systems. From these affiliations, retail clinics have expanded their services to include the management of chronic conditions such as diabetes, asthma, and hypertension.
As a result, retail clinics can treat the approximately 100 million adult Americans who suffer from these chronic conditions. That’s a large population of patients who now have an alternative source of primary care that can both see patients promptly and align with their trip to the grocery store. To further illustrate the significance of this expansion, consider this statistic: 76 percent of the U.S. population live within 5 miles of a Walgreens. In the Indianapolis area alone, where I live, at least 22 retail clinic sites are affiliated with local health care systems and 12 are currently or in the process of providing these expanded services.
So here’s the gap. To the best of my knowledge, all research questions around these new service lines are unanswered. Who is visiting retail clinics for chronic conditions? How does the quality of care for ongoing conditions compare to a traditional doctor’s office? What are the health outcomes associated with retail clinic visits for chronic care? Are these visits increasing overall spending or serving as a substitute for primary care office visits?
While these questions are just the low hanging fruit, I think retail health clinics are a growing care source that could have a significant impact on the US health care system. By not answering these questions, we risk not understanding how these expanded service lines along with more access points advance or hinder our larger health care goals of reduced health care spending and better health outcomes. As a result, we cannot equip policymakers with the knowledge they need to make informed decisions about health care delivery. Therefore, the expansion into chronic conditions at retail clinics deserves our attention and more detailed research.