Retail clinic or hospital ER? Choice isn’t what you might think

Emergency room sign

Even when a retail clinic is within a 10-minute drive, patients are still going to hospital emergency departments for treatment of common low-acuity conditions.

While some policymakers hoped the popularity of retail clinics across the country would cut expensive visits to hospital emergency rooms, a study (PDF) published in the Annals of Emergency Medicine finds that isn’t the case.

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Researchers at RAND Corporation found emergency rooms in close proximity to retail clinics didn’t experience a reduction in visits from patients with routine illnesses such as the flu, urinary tract infections and conjunctivitis. Using pooled data on ED visits from 2007 to 2012 at 2,053 hospitals in 23 states, the researchers looked at retail clinic penetration within a 10-mile drive and its effect on treatment of 11 low-acuity conditions.

Despite a significant growth in retail clinics—from 130 in 2006 to nearly 1,400 in 2012 in the communities studied—except for a slight decrease in low-acuity ED visits among privately insured patients, there was no change for patients with other types of insurance, the study found.

"Retail clinics may emerge as a way to satisfy the growing demand for healthcare created by people newly insured under the Affordable Care Act, but contrary to our expectations, they do not appear to be leading to meaningful reductions in low-acuity emergency department visits," lead study author Grant Martsolf, PhD, said in an announcement.

An accompanying editorial (PDF) offered theories as to why retail clinics didn’t impact ED visits, including that groups of people who are more likely to use EDs for treatment of common ailments do so because they have little access to other types of care, including retail settings.

"The answer is not to build more convenience settings, but to improve the value of existing settings by increasing the connectivity among providers and with longitudinal care,” wrote the editorial’s author, Jesse Pines, M.D., of the George Washington University School of Medicine and Health Sciences. "When people get sick and injured, there should be a system rather than the piecemeal network we have today in which each player is selling its own 'service.'"

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One example of such a system is Kaiser Permanente, he said, which includes connected hospital EDs, convenience clinics and physician offices. Telemedicine allows patients to seek advice about when and where to seek care and can direct patients to the most appropriate setting, whether it be urgent care, the ED or their physician, he said.