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| Patient Evaluation of Retail Clinic Care |
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by Marilyn W. Edmunds, PhD, CRNP; Laurie Scudder, MS, NP - November 30, 2009
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Patient Evaluation of Retail Clinic Care
Marilyn W. Edmunds, PhD, CRNP; Laurie Scudder, MS, NP
Patient Satisfaction With Retail Health Clinic Care
Hunter LP, Weber CE, Morreale AP, Wall JH
J Am Acad Nurse Pract. 2009;21:565-570
Study Summary
The first in-store medical convenient care clinic (retail health clinic) was opened in the metropolitan St. Paul/Minneapolis area in 2000. Since that time, the number of companies providing this new form of quick, inexpensive, and convenient healthcare has rapidly increased.
Usually staffed by nurse practitioners (NPs), the clinics do not claim to provide comprehensive primary care but offer a limited menu of nonemergent screening and routine treatment services. Common conditions that are treated include allergic reactions, upper respiratory infections, rhinitis, sinusitis, bronchitis, strep throat, otitis media, influenza, insect bites, urinary tract infections, and conjunctivitis. Patients use the clinics for routine immunization; pregnancy testing; school, sports, or work-related physical examinations; and preventive health screening for diabetes, tuberculosis, and hypertension. The healthcare providers use their clinical judgment to diagnose common acute health problems, order diagnostic tests, prescribe medications, and refer patients needing additional care.
The purpose of this study was to analyze data from patients who used 2 Arizona retail-based MediMin clinics. The survey was administered to evaluate patient satisfaction with care and patient patterns and preferences. A questionnaire was designed to answer: (1) how did the patient learn about the clinic and why was the clinic selected? (2) how long was the wait prior to being seen? (3) was the patient satisfied? and (4) would the patient return in the future? Additionally, the investigators asked whether the patient routinely shopped at the location and whether the patient intended to shop for groceries that day. Demographic data were analyzed to compare variations in survey responses on the basis of language preference (the language chosen for responses to the patient satisfaction survey, either English or Spanish) and variations in responses from patients at different store locations that might reflect differences in socioeconomic status.
The descriptive design used an anonymous, voluntary, self-report sample survey to gather data. The survey consisted of 8 multiple choice questions and 1 open-ended question and was given to patients at the completion of their visits from May 2006 through June 2007. A survey was distributed to every patient who received care at either clinic, and patients were asked to complete and return the survey prior to leaving the clinic or to mail the survey.
Findings:
62% of the respondents indicated that they learned about the MediMin clinics either from a sign at the store or from a friend.
Patients chose to obtain healthcare at a MediMin clinic because of convenient location, no appointment necessary, short waiting times, low cost, and friendly competent care. Only 13% of patients selected MediMin because of the presence of a pharmacy.
If they had not come to the clinic, 40% of respondents said they would have waited to see their doctor, 35% said they would have sought care at an urgent care center, 16% would have visited an emergency room, and 12% would not have sought care.
96% of respondents said they did not have to wait at all or waited less time than expected; 67% did not wait at all.
95% of respondents indicated that they were very satisfied or satisfied with the MediMin experience.
67% of those who responded in Spanish indicated that they always shopped at the host store, whereas only 21%-23% of those who responded in English indicated that they always shopped at the host store.
98% of respondents who visited the clinics said they would visit MediMin again for healthcare needs.
The researchers found that clients with varied incomes and different ethnicities valued the same attributes of retail health clinic care that are valued in other research studies on this topic: convenient location, no appointment necessary, short wait time, and low cost.
The high degree of patient satisfaction with retail clinic healthcare suggests that this type of entrepreneurial primary healthcare is meeting the needs of individuals. These clinics will likely continue or increase in number. Retail health clinics might be a viable source of employment for NPs.
Viewpoint
Retail health clinics seem to be here to stay. As a “disruptive innovation” (a change in the way something is typically done that is well received and creates new markets), retail clinics survive because they meet the needs of the public. That they are dominated by NP and physician assistant healthcare providers is an added testimony to the effectiveness of this group of providers. For NPs in particular, who see their roles very much as health educators, these clinics allow them to do what they have always done well: teaching, counseling, and advocating. Although other segments of the healthcare professions may try to emulate these clinics, NP-driven clinics in convenient locations seem likely to continue.
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| Jeff McElwain (Durango, Colorado) |
on 21 Jan 2010 at 7:53 pm |
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| The problem that I have with these types of clinics, regardless of the type of provider providing the service, is that they convey a message to the general public that mid-level providers only provide care for minor/urgent care type problems. I was trained to provide comprehensive primary care and I believe this is the level of care that we should be educating the public and other health care professionals that we are capable of providing. |
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| Karen Nichols PA-C, MHS (Milo, Maine) |
on 13 Jan 2010 at 3:25 pm |
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| I am not sure who the first NP Joan B. is kidding. Certainly, we may be under different regualtory boards but when it comes to the general public we are viewed as essentially the same type of practictioner. Each of our professions brings alot to the table and it often depends on the patient/employer as to whom they want to see as their provider or whom they hire. I work with a NP in our family practice and there is good comradery and respect. There is no ego that differentiates us...its about our collegues' attitudes that counts! |
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| Karen D (Stony Brook, NY) |
on 13 Jan 2010 at 11:49 am |
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| I am neither pro nor con the retail health care setting. I would like to know more specifics on how they are structurally set up as I admit to being ignorant to these facts. Truth be told, in NYS @ least, this type of set up is limited to we PAs depending upon the supervising MD set-up...not impossible, to overcome, but a fact. Truly entrepreneurial PAs and MDs can certainly set up a similar type retail clinic as well...taking away the invisibility issue. And a big kudo to M.Annal of CT, as a PA in a student health setting, a great deal of time and energy each day is spent on health education, counseling, and as a student patient advocate....not roles limited to the nursing professions. And thank you Marcia, I love and respect my NP colleagues too :-) |
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| Joan B. MS, NP-C, CPN (Columbus, Ohio) |
on 08 Jan 2010 at 12:29 pm |
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I understand the angst of the PA, but PAs and NPs are not the same. NPs are not regulated by the medical staff or medical boards. We function under our own license and are therefore held accountable to standards set by our Nursing Board. Granted,our scope of practice may be similar, but we are not necessarily traveling down the same path. As far as the fair, and right thing to do? How is it fair to mention two professions in the same breath when they are very different in their regulatory guidelines? We shouldnt strive to be the same, we are not. Strive to be your best, not the same.
Just MHO. |
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| Marcia Helfrick, CRNP (Pennsylvania) |
on 06 Jan 2010 at 12:55 pm |
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PAs are mentioned as providers in the clinics.
I love my PA colleagues and we build on each other's knowledge to provide even better care for our patients. |
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| Therese Schroeder, PA-C (Madison, WI) |
on 05 Jan 2010 at 1:32 pm |
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| I am a PA and currently work in family medicine and am a per diem provider with a retail clinic that is staffed by PAs, although Nurse Practitioners are welcome as well. We have another retail clinic in town that is staffed by NPs only. I attempted to apply for a position at this clinic as their literature and radio ads stated they are staffed by NPs and PAs. I was told that they hire NPs only, "but if I wanted to go back to school and become and NP" I could apply. Definitely still a need to educate regarding PAs. |
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| James Kilgore, PhD, PA-C (Birmingham Alabama) |
on 30 Dec 2009 at 3:59 pm |
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| Dave makes a good point about "invisibility" which must change. How do we change this issue? We must have more PA driven and published literature supporting the profession. As you note, this article was researched and published by two NP's. In March there will be a "Research Summit" in Washington, DCwhere issues such as this will arise. What do we need to do research on, where do we need to publish findings and how do we encourage academica, as well as the practicing PA to be involved in research and publishing? These are all questions that need answering. BUT until WE as PA's publish articles about our profession and its contributions then you must expect the professional doing the research will slant their results toward their own profession. |
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| M.Annal, PA, MSPAS (Connecticut) |
on 08 Dec 2009 at 3:10 pm |
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| Amazingly, even as a PA, I see my role as a "health educator'". I wasn't aware that was the realm of the NP. |
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| Dave Mittman, PA (Livingston, NJ) |
on 04 Dec 2009 at 10:12 pm |
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Nice to see although we know this.
Interesting PAs not mentioned at all. I for one think we should mention both professions. Why? Because it's fair and the right thing to do.
Otherwise, more research needs to be done on these clinics as they are great and really do serve a need. I have no doubt they will be doing more and more primary care in the future.
I also worry about becoming invisible in these.
Dave |
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