The American Academy of Pediatrics has issued its first policy statement regarding the use of retail-based clinics by children. They state that such clinics are not an appropriate source of medical care for children. They list 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.
The AAP also acknowledges that their use is likely to continue. The guidelines recommend that they follow the following principles:
- Retail based clinics should support primary care and the medical home model and refer patients back to the pediatrician for future care. If a child does not have a primary care doctor, they should assist patients in finding one.
- The RBC should communicate care back to the primary care doctor within 24 hours.
- They should use evidence-based medicine, following recommended pediatric guidelines. They should be required to participate in ongoing quality-improvement and quality-assurance programs.
- They should take precautions against spread of contagious diseases.
- Third-party payers should not provide financial incentives for using RBCs.
In general, these clinics are not an appropriate source of medical care for children. Children are not little adults and need completely different treatment than adults. Perhaps occasionally a teenager with a sore throat can use one to get a quick strep test if the pediatric office or urgent care is not open. Otherwise, children should not use them. They are not usually aware enough of pediatric guidelines and treatments or experienced enough in the care of children to provide the care they need and deserve.
Retail-Based Clinic Policy Work Group. AAP Principles Concerning Retail-Based Clinics. Pediatrics 118, 2561–2562. doi: 10.1542/peds.2006-2681 PMID: 17142546
