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Retail clinics may cut into primary care: study

(Reuters) - The health clinics in U.S. pharmacies and other retail stores may be convenient, but they may also take a bite out of the traditional doctor-patient relationship, according to a U.S. study.

Retail health clinics operate mainly out of chain pharmacies, but they're also in some grocery stores and "big box" stores like Wal-mart. They now number more than 1,300 nationwide, according to the non-profit RAND Institute - and among people with private health insurance, their use rose 10-fold between 2007 and 2009.

"The scope of care is limited," said Ateev Mehrotra, senior researcher on the study and an associate professor at the University of Pittsburgh School of Medicine, who also works at RAND. "And retail clinics themselves have expressed that they don't want to replace primary care providers."

Some doctors' groups are worried that the clinics could do just that. They say they're concerned not because of their bottom line, but because people who use clinics may miss out on comprehensive health services and a consistent "medical home."

Mehrotra's team looked at records from more than 127,000 U.S. residents with private health insurance. That included 23,000 people who used a retail clinic for the flu or other short-lived health problem at some point in 2008, while the rest had seen their primary care doctor.

The researchers, whose findings appeared in the Journal of General Internal Medicine, looked at whether the retail-clinic patients were less likely to visit a primary care doctor for their next minor health complaint over the following year.

They were. Overall, they had 40 visits to a primary care doctor per 100 patients, versus 68 visits per 100 among people who'd seen their regular doctor for their last cold or cough.

In an earlier study, Mehrotra's team found that for sore throats, ear infections and urinary tract infections, retail clinics and primary care doctors provided a similar quality of care. But the clinics did it at a lower cost, with an average visit running about $50 less, at around $110 as opposed to $166.

In the current study, there was no evidence that retail clinics interfered with routine care for a chronic medical condition. People with diabetes who visited a retail clinic were no less likely to get routine diabetes-related tests, like eye exams and blood-sugar checks, over the next year.

Many of those who visit retail clinics did it because they have no regular doctor, and did have less consistency in their care in terms of seeing the same provider more than once.

But Mehrotra said there is a push in the United States for more people to have a "medical home" - one provider who knows the patient and oversees most healthcare, a move seen as important to improving healthcare quality. SOURCE: http://bit.ly/SzJjl8

(Reporting from New York by Amy Norton at Reuters Health; editing by Elaine Lies)

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