In a perfect health-care system, everyone would have his or her own primary-care doctor, whose office is conveniently located and offers night and weekend coverage and same-day appointments if you need one. In reality, though, that’s not the case — at least not yet. The United States has the largest shortfall of doctors of any developed country, especially when it comes to primary-care doctors. In fact, survey research has shown that about 73 percent of Americans can’t readily access medical care on a night, weekend or holiday without going to the emergency room.
Into this void has come what’s sometimes referred to as the “quick care” movement — a proliferation of walk-in clinics in retail stores (think CVS, Walgreens, Walmart) as well as free-standing urgent-care centers that have night and weekend hours, treat a range of basic illnesses and injuries, and almost always are covered by insurance. They’re staffed by trained medical personnel — generally a nurse practitioner for a retail-store clinic and a physician for an urgent-care center, the more medically sophisticated (and less controversial) of the two. They also might offer substantially lower costs and shorter wait times than a trip to an overcrowded emergency room. Even better, the fees for each service are clearly posted.
Sounds like a good deal, but in-store clinics aren’t without potential problems. Chief among the criticisms is that they fragment your health care, turning it into a series of piecemeal visits with different providers rather than providing the continuity of care that you get from seeing the same provider over time. Proponents of the clinics argue that they aren’t attempting to replace doctors but to supplement their care at times when the doctor isn’t available — plus provide an option for people who currently lack a doctor of their own.
Here’s what you need to know about walk-in care and when you should — and shouldn’t — use it:
The evidence so far suggests that walk-in clinics provide care comparable to what you get at a doctor’s office, at least across the relatively basic range of conditions they treat.
In a study published in 2009 in the Annals of Internal Medicine, researchers examined the care given for three common illnesses — urinary-tract infection, a sore throat and an ear infection — at a group of retail clinics, urgent-care centers, emergency departments and physicians’ offices in Minnesota. They used 14 generally accepted indicators of quality, such as whether antibiotics were given for a child’s ear infection and whether high-risk patients with symptoms of a UTI were asked to give a urine sample, as guidelines advise. They found that the quality scores were similar at retail clinics, urgent-care centers and doctors’ offices — but lower at emergency departments.
“The takeaway is that most people who use a walk-in clinic should feel reassured,” says Ateev Mehrotra, an associate professor at Harvard Medical School and a policy analyst at the Rand Corp., who led the study.
The clinics have fairly robust systems of quality control in place. About 99 percent of the 1,700 retail clinics operating in the United States are members of the Convenient Care Association, an industry group that sets quality guidelines and standards of care. One of those standards is that all clinics use electronic medical records; another is that they fill in the patient’s primary-care doctor, if the customer agrees and if he already has a doctor. (Thirty to 40 percent of customers do not, according to Tine Hansen-Turton, executive director of the CCA.)
The debate over retail clinics is becoming more heated as they begin to segue beyond basic acute illnesses and vaccinations and into the management of chronic conditions such as diabetes, high cholesterol and high blood pressure.
In 2013, for example, Walgreens announced that about half of its 700 Take Care in-store clinics would start offering preventive health services such as cholesterol screening tests as well as treatment and management of chronic conditions including asthma, diabetes and high blood pressure. That’s where Consumer Reports’ medical experts draw the line.
“Complex or chronic medical problems that require continuity of care do not belong in retail clinics, period,” says Marvin M. Lipman, Consumer Reports’ chief medical adviser since 1967. In those cases, it’s critical to have a consistent primary-care provider or specialist who can help you manage the condition and who will monitor your progress over time.
Another potential concern is that the clinics’ location in retail stores, where patients can fill their prescriptions and potentially pick up other health items on the way, could create a conflict of interest, possibly biasing the professionals who practice there toward prescribing a drug even if you don’t need one. For that reason, it’s wise to ask the questions in the accompanying “Checklist” box if you visit a clinic and a drug treatment is recommended.
Here are some other basic guidelines from our medical advisers to stay safe and ensure a good experience:
● Make sure you go to the right facility. Retail clinics are appropriate for routine ailments or services: a flu or shingles shot, a strep test, a camp physical for a child. For something more urgent, such as a broken bone or a cut requiring stitches, go to an urgent-care center. (Make sure the physician on-site is board-certified.) For more-serious or life-threatening problems, dial 911 or get to an ER.
● Get everything that happened at the clinic in writing. That includes any diagnosis you get, instructions for follow-up care, the name of who treated you and any drugs prescribed or recommended.
●If you have a chronic condition such as diabetes or heart disease and can’t easily get in to see your primary-care doctor or regular specialist when you need to, consider looking for another doctor. Thanks to incentives under the Affordable Care Act, more private practices are adopting weekend hours and allowing walk-in or same-day appointments.
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.