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Monday, September 14, 2009

Docs in a Box

Retail Medical Clinics

'Doc in a box' is the tongue in cheek, and admittedly somewhat disparaging term many medical insiders call retail medical clinics, such as those found in Target or Wal Mart stores. These clinics purport to offer quick, accessible care for common medical problems, and as Rick points out in this week's podcast, they really should be called 'nurse in a box' since the majority are staffed by nurse practitioners.

The question is, how good is the care provided by these clinics? A study in the latest issue of Annals of Internal Medicine, Comparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses, examined this question. Researchers looked at care received for middle ear infections, sore throats and urinary tract infections in such clinics compared to that in physician offices, urgent care facilities and emergency departments. Measures of quality included cost of the visit, cost of prescriptions related to the visit, and whether patients received preventive care as well as an aggregate quality score.

Turns out that retail clinics fared very well indeed, costing substantially less than other medical providers for the care itself, with prescription costs and provision of preventive services about equal. Metrics I would have liked to see include how long it took to be seen and whether patients themselves were satisfied with their care. In any case, diagnoses were overwhelmingly correct as those seen in the clinics weren't subsequently seeking care for the same condition elsewhere.

Seems like people can feel confident that if they're seeking treatment for garden variety ailments such as a sore throat, a retail clinic will serve the purpose. Perhaps those of us in the medical establishment should embrace these clinics, since as Rick says, they remove some of the burden of care from emergency departments. One caveat: for continuing care, or continuity of care, it's still best to have a primary care provider in your corner.

Other topics in this week's podcast included two more from Annals: Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes and Systematic Review: Comparative Effectiveness and Harms of Combinations of Lipid-Modifying Agents and High-Dose Statin Monotherapy , and in JAMA, Typhoid Fever in the United States, 1999-2006. Until next week, y'all live well.

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