The American Academy of Pediatrics (AAP) has issued an update on its first policy statement, in 2006, on children and retail-based clinics (clinics in drug stores and other retail locations). The policy has not significantly changed; the AAP continues to oppose “retail-based clinics (RBCs) as an appropriate source of medical care for infants, children, and adolescents and strongly discourage[s] their use.” Instead, the AAP emphasizes the pediatric medical home for children. Parents cite convenience as the leading reason for using retail-based clinics.
In 2006, the AAP noted the following concerns, repeated in the 2014 statement:
- 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.
They make the following recommendations:
- RBCs are an inappropriate source of primary care for pediatric patients.
- Third-party payers should not offer financial incentives for patients to receive care at an RBC as opposed to the primary care doctor. The medical home is the best source of care, should provide continuous, coordinated, and comprehensive medical care, and should be compensated appropriately for such care.
- If a RBC sees children, it should:
- Use evidence-based pediatric guidelines
- Be engaged in quality review
- Promptly communicate with the pediatric medical home for all visits
- Refer patients back to the medical home and help patients who do not have one to establish one
- Make arrangements for after-hours coverage for situations that may arise after the patient is seen in an RBC
I agree with these recommendations. I think there can be some uncommon circumstances where it is acceptable (but not preferable) for a child to use a retail-based clinic, such as an older child with a sore throat, for example, when pediatric care is not available. In general, I have found the care by nurse practitioners in these clinics to be appropriate under circumstances such as these. 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.
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.
Committee on Practice and Ambulatory Medicine. Policy Statement: AAP Principles Concerning Retail-Based Clinics. Pediatrics 2014; 133:3 e794-e797; published ahead of print February 24, 2014, doi:10.1542/peds.2013-4080.
