Journal of General Internal Medicine

, Volume 28, Issue 4, pp 504–512

Retail Clinic Visits and Receipt of Primary Care

  • Rachel O. Reid
  • J. Scott Ashwood
  • Mark W. Friedberg
  • Ellerie S. Weber
  • Claude M. Setodji
  • Ateev Mehrotra
Original Research

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.

KEY WORDS

primary health care continuity of patient care acute diseases health services accessibility 

Supplementary material

11606_2012_2243_MOESM1_ESM.docx (474 kb)
ESM 1(DOCX 474 KB)

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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Rachel O. Reid
    • 1
  • J. Scott Ashwood
    • 2
    • 4
  • Mark W. Friedberg
    • 3
    • 5
    • 6
  • Ellerie S. Weber
    • 1
    • 2
    • 4
  • Claude M. Setodji
    • 2
  • Ateev Mehrotra
    • 1
    • 2
    • 3
    • 7
  1. 1.University of Pittsburgh School of MedicinePittsburghUSA
  2. 2.RAND CorporationPittsburghUSA
  3. 3.RAND CorporationBostonUSA
  4. 4.H. John Heinz School of Public Policy and ManagementCarnegie Mellon UniversityPittsburghUSA
  5. 5.Division of General Internal MedicineBrigham and Women’s HospitalBostonUSA
  6. 6.Harvard Medical SchoolBostonUSA
  7. 7.University of Pittsburgh School of MedicinePittsburghUSA

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