The very disparaging term 'doc in a box,' is popular to describe what Rick calls "retail clinics," or RCs, in this week's PodMed, and the danger of utilizing RCs to provide medical care to children, based on a study in JAMA Pediatrics. These clinics, as most people know, often are found inside a retail establishment such as Target or a pharmacy such as Walgreen's. They're often staffed by nurse practitioners, physician assistants, or sometimes registered nurses, and they provide rapid assessment and testing for a limited range of very common medical complaints as well as ongoing management for conditions such as high blood pressure or type 2 diabetes. As I confide in the podcast, I've sought their services for a routine pre-athletics physical for one daughter with an unremarkable medical history, when her own pediatrician advised a six week wait for such an assessment!
Researchers surveyed almost 1500 parents who utilized 19 pediatrics practices in the Midwest, asking them about their experience with RCs. The instrument was a self-administered paper questionnaire which took about five minutes to complete. Both parents who had and had not visited an RC for medical care for their child were asked to participate. Those parents who had not utilized such a clinic were asked why not, while those who did were asked about their most recent visit. Parents were asked about the reason for the visit, how they had learned about the RC they chose, and why they had not gone to their child's usual provider on this occasion. Additional questions regarding the day of the visit, the time of day, how care was paid for and how long the wait to see the provider lasted were also queried. Data was gathered on what the diagnosis was and what care was prescribed, especially antibiotic prescription.
Findings of the study were mostly not surprising: parents who used RCs for themselves were more likely to take their children there, were older and more likely to have more than one child than parents who did not. Reasons for choosing an RC included convenient hours among almost 40% of respondents, even though almost half of visits to RCs took place between 8am and 4pm on weekdays. Parents also cited the unavailability of an appointment as a reason. Most visits were for URIs, ear infections or colds and flu, and very concerning, 85.2% of children with an ear infection, 78.6% of those with a sore throat, and 67.7% of those with a cold or flu were prescribed antibiotics, even when tests did not reveal a bacterial infection. And along with that concern, many parents reported they did not subsequently inform their child's pediatrician of the visit.
Rick and I both agree that this is potentially problematic, especially with regard to continuity of care. Since RCs are privately owned they are unlikely to generate an electronic record to the pediatrician's office, so a complete health history will not be available and could have deleterious consequences for the health of a child. Rick concludes that physicians need to take note of this study and begin asking about RC visits routinely as well as modify office practices to better serve patients.
Other topics this week include maternal smoking and child behavior in JAMA Psychiatry, rabies transmission from a solid organ transplant and breast cancer survival in white versus black women, both in JAMA. Until next week, y'all live well.