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A flu shot // A checkup // Earwax removal // And more recently, monitoring of your asthma, diabetes and hypertension—a new way to encourage repeat visits.

Megastore Medicine

By David Howard // Photographs by Peter Rad // Fall 2010
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Megastore Medicine, opener

Peter Rad

Despite being only 40 years old and reasonably fit, Jeremy Katz has high blood pressure, elevated cholesterol and a “nasty family history” (his description) of heart disease, colon cancer and type 2 diabetes. Katz, who lives in Salisbury Township, Pa., takes several medications and has to see his doctor frequently. It’s tough to find time for those visits, so Katz was interested to learn that two drugstore chains, CVS and Walgreens, recently launched programs at their in-store clinics to help people manage chronic medical conditions. The idea of being able to drop in at the drugstore for a quick blood pressure check while doing other errands seemed worth considering. Then the pharmacy would e-mail test results to his regular physician.

But the more Katz pondered that scenario, the more questions he had. Would the reading be accurate if he was hustling around dropping off FedEx packages and buying groceries? And what if the screening showed a spike in his blood pressure? When that happened in January, it turned out Katz had a kidney problem, and he spent a long weekend in the hospital. Would the nurse-practitioners who staff retail clinics have picked up on that? Their job would be made harder by his involved medical history. “It’s complicated for a patient to remember—and for a clinic in a Walgreens to tease out,” he says.

Katz’s ambivalence might be emblematic of what’s to come as hundreds of the nation’s retail health clinics—which until now provided only in-and-out treatments for common ailments—roll out plans to manage such chronic conditions as hypertension and diabetes. In announcing this expansion, the clinics’ corporate parents say they are filling a serious need. Hypertension, the focus of the new Walgreens program, afflicts 74.5 million people in the United States, many undiagnosed. The retail clinics are nothing if not convenient—found in the likes of Target and Walmart as well as in drugstores—and if that makes people more likely to get their blood pressure checked, it could prove valuable in reducing the incidence of stroke, atherosclerosis, kidney disease and heart failure.

But profit motives, too, have been a factor in the clinics’ decision to broaden services, and many physicians are skeptical about the clinics’ ability to take over much of the doctor’s own role. Some physicians have even resolved to beat the clinics at their own game, making their practices more accessible. While the outcome may not be decided for some time, there’s little question that the proliferation of retail clinics has already become a significant development in how health care is delivered.

When they first appeared, in Minneapolis in 2000, retail clinics were a curiosity, occupying corners of pharmacies. They generally included such user-friendly features as clearly posted pricing (often in the $55 to $65 range) and hours of operation that stretched into evenings and through weekends. Operators of these businesses limited costs by staffing them with nurse-practitioners and physician’s assistants. Most states require that a physician collaborate with the NPs and PAs, but the extent of that collaboration differs.

At first the medical community was wary. Would care be adequate? Would NPs and PAs know what to treat and what to refer to a physician? But during the next six or so years, the clinics’ increasing prevalence, with few apparent problems, won over many skeptics. The clinics started small, limiting their scope to several common, easily treated acute conditions—normally, upper respiratory infections, bronchitis, middle and external ear infections, pharyngitis, conjunctivitis and urinary tract infections. Many clinics also offered immunizations, simple lab tests and blood pressure screenings.

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1. “Retail Clinics: Update and Implications,” by the Deloitte Center for Health Solutions, 2009. For a business-focused perspective on retail clinics—and the underlying economic imperatives behind their expansion into chronic care—this report is as thorough as it gets.

2. “Retail Clinics, Primary Care Physicians, and Emergency Departments: A Comparison of Patients’ Visits,” by Ateev Mehrotra et al., Health Affairs, September/October 2008. For those who doubt the relevance of retail health clinics, this study is eye-opening, showing that patients suffering from 10 acute health problems are flocking to them.

3. “Comparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses,” by Ateev Mehrotra et al., Annals of Internal Medicine, September 2009. The most noteworthy finding: The care at retail clinics is just as good as that given by doctors’ offices and emergency departments—at least for otitis media, pharyngitis and urinary tract infections.

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