Should children use retail-based clinics for heath care? The short answer: no; it is almost never a good option for kids.
Retail-based clinics (RBCs), such as Minute Clinic (CVS) and Walgreen’s Clinics, are growing rapidly across the country. Target, Wal-Mart, and others may be getting into the business as well. Patients like them mostly for convenience, with no appointment needed and more hours in evenings and weekends than many doctor’s offices. There is also a perception that the cost is less than a doctor’s office, which is sometimes true.
For adults, these clinics may meet a need or provide an adequate service, though there are problems with continuity of care, as well as access to medication and other medical history. However, children are not little adults, and there are more problems with children using them for sickness and even more so for any kind of routine care. In fact, the American Academy of Pediatrics issued recommendations in 2006, and again in 2014, stating that retail based clinics were not an appropriate source of medical care for children. The recommendations cite the following concerns:
- Fragmentation of care
- Possible decreased quality of care
- Provision of episodic care to children who have special needs and chronic diseases, who may not be readily identified
- Lack of access to and maintenance of a complete, accessible, central health record that contains all pertinent patient information
- Use of tests for the purpose of diagnosis without proper follow-up
- Possible public health issues that could occur when patients who have infectious diseases are in a commercial, retail environment with little or no isolation (eg, fevers, rashes, mumps, measles, strep throat)
- Seeing children who have “minor conditions,” as will often be the case in an RBC, is misleading and problematic. Many pediatricians use the opportunity of seeing the child for something minor to address other issues in the family, discuss any problems with obesity or mental health, catch up on immunizations, identify undetected illness, and continue strengthening the relationship with the child and family. Visits for acute illnesses are important and provide an opportunity to work with patients and families to deal with a variety of other issues.
I worry most about inappropriate care due to lack of familiarity with children and pediatric illnesses and guidelines. Most providers in these clinics are adult for family medicine trained nurse practitioners who may or may not have much experience with children. This is part of a larger problem that I often see, where children visit a community hospital emergency room or non-pediatric urgent care and receive completely inadequate and inappropriate care. These doctors do not seem to be familiar enough with common conditions and diseases in children, or the most current recommendations, and the child receives either too little or too much care (tests, procedures, labs, x-rays, medications), both of which can lead to poor outcomes.
I also worry about a lack of appropriate care due to missing past medical history, family history, allergies, medication use, etc. when the clinic does not have access to the child’s medical records. This can lead to inappropriate care when the child is sick, and it makes it virtually impossible by definition to receive preventive care such as sports physicals or annual physicals, at a retail-based clinic.
Using such clinics also presents problems such as contacting someone when there is a problem with a medication, a question, or when follow-up is necessary. At least care from an urgent care is usually more integrated, especially in pediatrics, with immediate faxes to the primary care provider.
I think there can be some circumstances where it is acceptable (but not preferable) for a child to use a retail-based clinic, such as a teenage child with a fever and sore throat, at night or on a weekend, when pediatric care is not readily available, to check for strep throat. Under these circumstances, they can be helpful and convenient. In general, I have found the care by nurse practitioners in these clinics to be appropriate under circumstances such as these. In fact, it is sometimes better than the care I see children receiving at community emergency rooms and adult-oriented urgent care clinics for similar minor illnesses.
It is completely inappropriate, however, for children to receive immunizations, sports physicals, and any other kind of preventive care at a retail-based clinic. These must take place in a medical home, where a child’s medical and family history are available, growth and development are tracked, care is coordinated with specialists, and up-to-date recommendations and guidelines are followed by someone specialized in the care of children.
It is not advisable for young children to use these clinics, or for any child to use them for anything but the most straightforward of conditions. Children should not use them except for unusual circumstances when no other option is available, and they should never use them for physicals, vaccines, or sports physicals.
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