ABSTRACT
BACKGROUND
An increasing number of patients are visiting retail clinics for simple acute conditions. Physicians worry that visits to retail clinics will interfere with primary care relationships. No prior study has evaluated the impact of retail clinics on receipt of primary care.
OBJECTIVE
To assess the association between retail clinic use and receipt of key primary care functions.
DESIGN
We performed a retrospective cohort analysis using commercial insurance claims from 2007 to 2009.
PATIENTS
We identified patients who had a visit for a simple acute condition in 2008, the “index visit”. We divided these 127,358 patients into two cohorts according to the location of that index visit: primary care provider (PCP) versus retail clinic.
MAIN MEASURES
We evaluated three functions of primary care: (1) where patients first sought care for subsequent simple acute conditions; (2) continuity of care using the Bice–Boxerman index; and (3) preventive care and diabetes management. Using a difference-in-differences approach, we compared care received in the 365 days following the index visit to care received in the 365 days prior, using propensity score weights to account for selection bias.
KEY RESULTS
Visiting a retail clinic instead of a PCP for the index visit was associated with a 27.7 visits per 100 patients differential reduction (p < 0 .001) in subsequent PCP visits for new simple acute conditions. Visiting a retail clinic instead of a PCP was also associated with decreased subsequent continuity of care (10.9 percentage-point differential reduction in Bice–Boxerman index, p < 0 .001). There was no differential change between the cohorts in receipt of preventive care or diabetes management.
CONCLUSIONS
Retail clinics may disrupt two aspects of primary care: whether patients go to a PCP first for new conditions and continuity of care. However, they do not negatively impact preventive care or diabetes management.
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Acknowledgements
We thank Aetna Health Plan for donating the data and answering our technical questions. We also thank Martin Gaynor, Ph.D. at Carnegie Mellon University for his useful input on this work.
Ms. Reid had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
This project was funded by the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) Initiative. Ms. Reid was supported by a Clinical Research Fellowship from the Doris Duke Charitable Foundation via the University of Pittsburgh School of Medicine, and a Clinical and Translational Science Institute Multidisciplinary Predoctoral Fellowship, awarded through the Clinical and Translational Science Institute and the Institute for Clinical Research Education at the University of Pittsburgh (Grant 5TL1RR024155-05). Dr. Mehrotra was supported by a career development award (KL2 RR024154) from the National Center for Research Resources, a component of the National Institutes of Health.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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Reid, R.O., Ashwood, J.S., Friedberg, M.W. et al. Retail Clinic Visits and Receipt of Primary Care. J GEN INTERN MED 28, 504–512 (2013). https://doi.org/10.1007/s11606-012-2243-x
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DOI: https://doi.org/10.1007/s11606-012-2243-x