Retail clinics and AAP care about children

The recent American Academy of Pediatrics-issued policy statement opposing retail clinics is disheartening to those of us practicing in this setting. The AAP’s commitment to the medical home model of care for children is the crux of the opposition. The AAP argues that retail clinics fragment care, miss opportunities for preventive services and fail to provide adequate follow-up for patients. Both the Convenient Care Association and AAP are dedicated to ensuring high-quality care for patients. With similar missions, we must work together.

Retail clinics were never intended to be the sole source of care for patients. For instance, retail clinics currently do not see patients younger that 18 months of age because of issues related to the need for certain vaccines and developmental assessments that are not in our scope of service. From the inception of this innovative model of care, the intent was never to replace a patient’s primary care provider, but to bridge the gap (i.e., when the PCP was not available) and to assist those patients with no PCP in developing a relationship. Up to 60% of patients — adults and children — who utilize retail clinics for care report not having a PCP, thus, retail clinicians become an access point for care.

It is important to note that nurse practitioners have long been leaders in the medical home model. Every retail clinic group has policies requiring communication with the patient’s PCP via written communication either carried by the patient or sent by electronic methods (e.g., fax and secure email). In addition, patients who have out-of-scope conditions and those requiring ongoing care by a PCP or specialty provider are connected with the needed service, making these clinics an important portal for patients into the healthcare delivery system.

With the implementation of the Patient Protection and Affordable Care Act, the need and demand for retail-based clinics is expected to grow. Efforts to increase record integration and vaccine database registries are underway across the United States. These types of improvements will mean improvement in coordinated care across multiple settings and lead to improvements beyond just pediatric care.

Rather than becoming adversaries in care, retail clinics and the American Academy of Pediatrics must work together to ensure that every patient receives not only appropriate acute care, but also preventive services with optimal follow-up.