DOCTORS SKEPTICAL OF IN-STORE CLINICS

WENDY TOTH

AUSTIN, Texas - While the number of supermarket and other retail health clinics expands nationwide, doctors warn that patient safety may be compromised by these in-store services.

The Texas Medical Association here is among those that have raised concerns over the clinics' ability to coordinate with local physicians, opening patients to the possibility of duplicate care and mistakes related to serious underlying illnesses.

"Patients may get a false sense of security from these clinics," said Dr. Susan Strate, chairman of the Texas Medical Association Council on Socioeconomics here.

Strate explained that patients may use the clinics for certain symptoms and assume, after treatment, that "everything has been taken care of" when there may be more serious issues that need evaluation.

On the other hand, with a lack of complete patient history, the nurse practitioners who generally run retail health clinics may "duplicate services that the patient has received from a primary care physician, or provide services above and beyond what the patient actually needs," Strate said.

The solution, according to Paul Kaufmann, chief executive officer of WellnessExpress Clinic, San Ramon, Calif., which operates inside units of Longs Drug Stores, Walnut Creek, Calif., is to limit the extent of services offered.

"There is a valid concern over not being able to access each patient's full medical history and it is for that reason that in-store clinics provide a limited scope of services," Kaufmann said.

Each clinic should have a specified, appropriate list of conditions it will treat, a relationship with a local family physician for supervision of care, and must be committed to notifying the patient's physician of the encounter, according to Dr. Larry Fields, president of the American Academy of Family Physicians, Leawood, Kan.

Kaufmann, whose clinics are supervised by physicians who provide consultation via telephone, agreed. "This is a supplemental form of health care delivery, for basic needs," he said.

"While it is appropriate that the clinics limit care to common, minor, non-urgent illnesses like sore throats, proper follow-up care must be ensured and coordinated with physicians," Strate said.

The risk of not having adequate follow-up care with a physician after visiting a clinic exists for patients both with and without insurance, Strate said. "Clinics have to provide patient education on the extent of services provided and be adamant about the importance of follow-up care," she said. "It takes a lot of patient communication."

To avoid patients' expecting follow-up treatment at the clinic, which could cause them to view clinics as a "medical home," WellnessExpress clinics will only see each patient one time for a particular illness or condition, a policy that is enabled by a proprietary network of electronic record keeping, Kaufmann said.

"We refer patients to a doctor for follow-up care and either print out a record of their visit for them to bring to their doctor or fax the information directly to that doctor," Kaufmann said.