Data suggests that continuity of care is limited when a patient visits a retail health clinic for chronic care management.
Primary care and retail health clinics need to get on the same page about continuity of care, according to a recent study published in the Journal of the American Board of Family Medicine.
These findings come as more and more patients visit retail health clinics as a part of their primary care. Retail health clinics – which are usually staffed with nurse practitioners or physician assistants, offer minor acute care services for a low price, and are centrally located in many retail stores – have come to fill in a gap in convenient access to care.
“About 44% of all retail clinic visits occur when traditional primary care physicians’ offices are closed,” explained the researchers, who come from the University of Texas. “These clinics accept a large percentage of insurances and visits may cost less than at a traditional primary care physician’s office.”
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But despite improving patient access to care, retail health clinics raise a lot of questions about care quality. Concerns abound about patients inappropriately accessing chronic care management services in retail spaces and whether those patients are ultimately sent to their primary care providers.
This becomes even more important for older patients, who are more likely to have at least one chronic illness.
This latest study revealed that there are some care coordination pitfalls for senior patients, especially for those accessing retail clinics for chronic care.
The researchers analyzed the relationship between retail health and primary care clinic visits in the Houston area during 2015. Looking at data for more than 366,000 Medicare beneficiaries in the area, the team sought to understand how often an older patient receives care in a retail clinic and then experiences a meaningful transition of care to their primary care provider.
Overall, retail health clinic visits among this population were fairly uncommon, the researchers said. There was an average of 2.32 visits per 1,000 Medicare beneficiaries in 2015, a stark contrast to the 6.5 visits per 1,000 patients ages 18 to 64.
But although most of these visits involved minor acute care services or vaccinations, the researchers took note of the 10 percent of all clinic visits that centered on chronic disease management. This was a cause for concern for the researchers, who pointed out that older patients were far more likely to experience one or more chronic illness than younger patients.
“While retail clinic use was lower in the elderly population compared with the younger populations, our findings of minimal PCP follow-up raise concern about quality, coordination, and outcome of care among elderly retail clinic users,” the team said.
Adequate chronic disease management among older populations is essential, the researchers explained, and requires deep patient-provider relationships and strong patient engagement. In short, chronic disease management for older populations usually best takes place with established primary care providers, not in a retail space.
“Optimal [chronic disease management] for conditions, such as congestive heart failure, require a stable PCP to establish long-term patient-PCP interpersonal trust, to coordinate care and informational translation across multiple providers for preventive, acute, and chronic care needs,” the researchers noted.
On the whole, most of the patients visiting retail clinics did so because they did not have an established primary care provider. But for those who did visit the retail clinic and had an identified PCP, the researchers found patients still were not being referred back to their primary care following a clinic visit. This indicates a lapse in care continuity between retail clinics and primary care.
“Continuity of care is key to health maintenance and the patient centered medical home, especially in Medicare patients with multimorbidity,” the researchers stated. “There is potential for poor outcomes among those using retail clinics for CDM: comprehensive care approaches are less likely in the setting of a walk-in retail clinic visit model.”
To remedy this, the healthcare industry must emphasize stronger partnerships between retail clinics and primary care providers.
“Retail clinic use by Medicare beneficiaries will likely grow, so approaches to improve care coordination and communication between retail clinic providers and PCPs are needed,” the team explained.
Potential solutions may include:
- A visit scoring system in which the retail clinic gauges the severity of an at-risk patient’s health. Certain severity levels will prompt a referral to primary care.
- Driving communication between primary care and retail clinic providers, ensuring they touch base when they share a patient.
- Implementing integrated EHRs that pass along visit notes between primary care and retail clinic providers
“Primary care discontinuity among elderly retail clinic users in our study underscore the need for better systems to improve integration and coordination of retail clinic care,” the researchers concluded. “Our findings also highlight the need for long-term national studies of the impact of retail clinic use and uncoordinated care or ‘visit entropy’ on rehospitalizations and other outcomes that matter to clinically complex elders. Data from such studies can guide policy makers, health system leaders and clinicians on ways to improve quality and continuity of care among retail clinic users.”
Date: August 09, 2019