Retail-based health clinics in pharmacies or big box stores may seem more convenient and less expensive compared to seeing a pediatrician, but these clinics do not provide children with the high-quality, regular preventive health care that they need, according to the American Academy of Pediatrics in an updated policy statement released online today.
Retail-based clinics or convenient care clinics are usually run by nurse practitioners or physician assistants that see patients quickly without appointments and often for less money than pediatric offices or emergency departments. This policy statement is not totally unbiased since these establishments compete with pediatricians for patients and profits, but the criticisms of these offices still has validity.
The following is a list of the AAP’s concerns and my thoughts on them:
Care is fragmented. I am glad that my patients can go and get influenza vaccine and other immunizations that they may need for school. However, this creates some problems. Not only do these clinics not inform the primary office or the city-wide immunization registry about what immunizations they have given, but they do not look at long-term problems that a pediatrician would ask about during a visit such as school problems, excess weight gain or emotional difficulties.
Decreased quality of care. Most of the practitioners are not trained in pediatrics and do not know the differences in care between adults and children.
Provision of episodic care to chronically ill children. Simple things may not be asked that any pediatric practitioner would know. Some examples: Do not give nasal influenza vaccine to a child with asthma. Do not approve a child with one kidney for contact sports. Are chronically ill children taking their daily medicines such as penicillin in children with sickle cell disease?
Lack of access to and inability to add to the child’s central health record. A pattern of illness can be easily missed when all the records are not in one place.
Use of diagnostic tests without follow up. A primary doctor at a retail-based clinic may not know about repeated urine infections and thus no kidney work up would be done.
Exposing a public place to infectious children. Although a pediatric office waiting room is not that healthy either.
The AAP recommends a “medical home” for each child where a practitioner practices the promotion of healthy life style and reacts in an organized fashion to patterns of illness. Tomorrow, look for my post on two other AAP policy statements released this week about recommendations for preventative care and off-label use of drugs in children. Both reiterate the importance of the “medical home.”
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