Retail clinics: Concept expands--not threatens--primary care

Retail health isn't an isolated part of healthcare and the industry should view it as part of the solution, says Nancy Gagliano, M.D., senior vice president of CVS Caremark and chief medical officer for CVS MinuteClinic, the largest retail clinic provider in the country.

Gagliano (pictured right), one of the panelists at this year's American Hospital Association's annual meeting, told attendees that retail clinics provide patients with access to basic healthcare, eliminating unnecessary visits to emergency rooms.

"If a patient has a fever of over 103, the retail clinic is not the right place. If you arrive with a drill stuck in your hand, we will send you to the hospital," she says.

CVS provides walk-in care, seven day a week, evenings and holidays in 1,500 MinuteClinics across the country, which provides 60 percent of the U.S. population access to healthcare. Nurse practitioners run the clinics and use evidence-based guidelines embedded into the electronic health record to treat patients, Gagliano says.

The clinics, she says, are accredited by the Joint Commission and connect patients with medical home practices and primary care physicians within 24 hours of a visit. And if patients who don't have a primary care physician arrive for care, the clinics provide them with a list of potential providers.

It's staggering how many of these patients don't have primary care providers, Gagliano says. Fifty percent of patients who use the clinics report they don't have one and the reasons for that vary, she says. Perhaps they couldn't get an appointment or they don't like primary care doctors. But, she says, the problem will grow due to the shortage of primary care providers.

"Our role is a safety net. We provide access at low cost, high quality and get patients to primary care," she says. If the patient does have a primary care provider, the physician will receive a copy of the MinuteClinic record. Patients who don't have one receive a list of local providers in the community.

Patients don't like taking time off from work to see a doctor, so the clinics provide them with a convenient alternative. "It's also an extension of primary care without costing a lot of money," Gagliano says.

CVS is in the process of integrating its electronic medical records with affiliated practices and systems so that physicians have easy access to the record of the visit. The integration also will allow MinuteClinic staff to easily pull up the patient's medical record to view allergies and prescribed medications.

"It will allow us to communicate information from our organization to our affiliated health systems and back and forth," Gagliano says.

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