The doctor’s not in
but the nurse practitioner is

Six-year-old Peter woke up one morning with a fever and a sore throat – common symptoms of strep throat. But rather than taking him to his pediatrician, his mom, Kristin, took him to MinuteClinic, a retail-based health clinic. The nurse practitioner there administered a rapid strep test, which came back positive. Peter received a prescription for an antibiotic, which was filled on-site, and the family was on its way in barely 30 minutes.

Since that morning two years ago, Kristin has taken Peter and his 5-year-old sister Katie to other retail clinics several times for strep throat, ear infections, and pink eye.

The retail clinic health care model began in 2000 with MinuteClinic. Staffed by nurse practitioners and physician assistants, the clinics treat a limited number of conditions in offices located in pharmacies, shopping malls, grocery stores, and other public places. Clinics offer up-front pricing on the diagnosis of common conditions like strep throat and ear infections, and also provide vaccinations. Patients are accepted on a walk-in basis and generally spend about 15 minutes with a professional.

In Minnesota, parents can choose from MinuteClinics located in CVS Pharmacies and public shopping areas, NOW Express Care located in Cub Foods stores, and Target Clinics. Each clinic limits the conditions it will diagnose and treat, and they may restrict the ages of patients.

For parents like Kristin, retail clinics are a convenient way to diagnose and treat common illnesses. The family lives in suburban Washington County, more than 30 miles from their pediatrician. A neighborhood retail clinic in a larger store simplifies Kristin’s life. She can have a child’s illness diagnosed, fill a prescription, and pick up a few groceries before returning home.

The convenience of retail clinics is causing a change in traditional medical clinics, too, according to Linda Berntson, manager of operations with MinuteClinic. “Doctors are now open in the evening and have Saturday and Sunday appointments. Competition is a good thing,” she says, if it improves access to medical care.

But finding an appropriate retail clinic can be just as important as finding a primary care doctor.

The National Association of Pediatric Nurse Practitioners, the American Academy of Family Physicians, and the American Medical Association all offer suggestions on the development of retail clinics to ensure they provide high-quality medical care. While it does not support the use of retail clinics to treat children, the American Academy of Pediatrics lobbies for many of the same guidelines.

Dr. Loie Lenarz is a board-certified family-practice physician with Fairview Health Systems. As the chief clinical officer, she contributed to the development of the Target Clinics.

“Whenever possible,” she recommends, “find a retail clinic that you know or believe to connect back to your own physician or clinic.” Look for a clinic that maintains electronic health records and will send information to your primary care provider. Find out how – and how quickly – the clinic communicates with physicians. Physicians want to know how often a child is getting sick and with what illnesses, to determine whether a further evaluation is necessary, explains Lenarz.

Lenarz and the professional medical associations all emphasize the importance of retail clinics using care that has been scientifically proven to be effective. Ask the clinic you visit how often they confirm electronic records are received by the primary care provider and whether they help schedule follow-up care.

Find out how the clinics collaborate with doctors. Ask the retail clinic about the ratio of physicians supervising the nurse practitioners or physician assistants, what percentage of charts doctors review, how often the doctors and midlevel care providers meet, and the doctor’s availability for phone consultation. At some clinics, one doctor might supervise 40 midlevel providers, while in other cases the ratio might be one doctor to two nurse practitioners.

Parents can also talk with their pediatrician about finding a retail clinic, but be aware that not all doctors are receptive of the new trend. “Many physicians reasonably have some hesitancy about retail clinics because there is a wide spectrum of quality,” says Lenarz.

C.C. Strom is a Minneapolis writer and mother of two.

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