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Kids with pediatricians also getting care at clinics

By Andrew M. Seaman

NEW YORK (Reuters Health) - Even children who have pediatricians sometimes get care from retail medical clinics like the ones in large drugstore chains, according to a survey of parents near St. Louis.

Almost a quarter of the parents surveyed while at a pediatrician's office had taken their children to retail health clinics, many saying they found it more convenient than going to their child's regular doctor.

"Even parents whose children have a primary care pediatrician who they know and trust may not always believe they have convenient and timely access to their care provider," writes Dr. Jane Garbutt and her colleagues in JAMA Pediatrics.

Retail health clinics, which are often found in the pharmacy sections of chain stores such as CVS, Walgreens or Target, are usually staffed by nurse practitioners or physician assistants and are able to provide care for a number of common illnesses, like colds.

More than 6,000 retail health clinics are expected to be operating across the U.S. by the end of 2013, according to the researchers.

Some medical organizations, including the American Academy of Pediatrics, say retail clinics are not appropriate sources of medical care for children because their use may "fragment care" and ultimately lower the quality of care kids receive.

Still, Garbutt, from the Washington University School of Medicine in St. Louis, and her fellow researchers write that there hasn't been much research into how parents and children are using retail clinics.

For the new study, the researchers distributed surveys to parents in the waiting rooms of 19 pediatricians' offices around the St. Louis area between December 2011 and April 2012.

Of the 1,484 parents who completed the study, 344 - about 23 percent - said they had taken their children to a retail health clinic. About half of those had taken their kids to a clinic in the past year.

About three-quarters of the parents who took their children to a clinic had also considered taking their children to the pediatrician first, but 37 percent said the clinics' hours were more convenient and about 25 percent said there were no appointments available at the pediatrician's office.

About 41 percent also said they didn't want to bother the pediatrician after hours or they didn't think the conditions were serious enough to warrant a visit to the doctor.

The most common ailments treated at the clinics were sore throats, ear infections, colds and flu.

Dr. Marlene Miller, vice chair of quality and safety at Johns Hopkins Children's Center in Baltimore, said what worries her most about retail clinics is the discontinuity of care, especially when clinics or parents don't inform primary doctors about medicines or other treatments the child has received.

"A kid who has recurrent ear infections, I'm going to pick an antibiotic differently… If suddenly I don't know that universe, I can't manage that patient well," Miller, who was not involved in the new study, told Reuters Health.

About 43 percent of the clinics visited by parents taking the survey recommended that the kids receive follow-up care from their pediatrician, and roughly 40 percent of parents informed their pediatricians of the retail clinic visits.

"I would not encourage going to these clinics, but I understand the needs at times," she said.

In an editorial accompanying the new study, Dr. Edward Schor from the Lucile Packard Foundation for Children's Health in Palo Alto, California, says that like it or not, pediatricians may have to change their practices to compete with retail clinics.

"Pediatricians need to analyze families' desire for convenient, high-quality care at low cost and balance that desire against their own needs for practice autonomy, revenue, professional satisfaction, and personal time," he writes.

Miller said it's hard to know whether the number of retail clinics will continue to grow, but it's important to keep primary care providers in the loop if parents do decide to use them.

"If parents have to go, your main doctor needs to know that you went and what they did," she added.

SOURCE: http://bit.ly/Ms92Cy JAMA Pediatrics, online July 22, 2013.

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