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Retail clinics do not reduce ER visits for minor ailments

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The opening of retail medical clinics near hospital emergency departments does not reduce visits to the emergency departments for minor health ailments, according to a new RAND Corporation study.

There has been hope that retail clinics will help lower health care costs by diverting care from costly emergency departments to more convenient and lower-cost retail clinics, but the new findings do not support that idea.

The study examined the experiences of more than 2,000 emergency departments across 23 states over a five-year period and found the opening of retail medical clinics was not associated with any significant reduction in visits to emergency departments for 11 low-acuity ailments such as respiratory infections and ear aches. The findings are published online by Annals of Emergency Medicine.

"One hope for retail clinics was that they might divert patients from making expensive visits to the emergency department for minor conditions such as bronchitis or urinary tract infections," said Grant Martsolf, lead author of the study and a policy researcher at RAND, a nonprofit research organization. "But we found no evidence that this has been happening.

"Instead of lowering costs, retail clinics may be substituting for care in other settings such as primary care practices or spur some patients to seek care for problems they previously would have treated on their own."

Retail clinics are walk-up medical providers typically located in drug stores such as CVS and in retail chain stores such as Target and Wal-Mart. Most often care is provided by nurse practitioners rather than by physicians.

First appearing in 2000, there are now nearly 2,000 retail clinics across the United States and they receive more than 6 million patient visits annually. Visits to retail clinics are less expensive than visits to physician offices or emergency departments, both because fees are lower and fewer tests are performed.

Researchers used information from the federal Healthcare Cost and Utilization Project State Emergency Department Databases from 2006 to 2012 to combine emergency department use with information about the opening of retail clinics obtained from Merchant Medicine, a research firm that tracks trends in walk-in medicine.

Retail clinical penetration was measured as the percentage of an emergency department's catchment area that overlapped with a 10-minute drive of a retail clinic. The 11 low-acuity conditions studied are commonly seen in both retail clinics and hospital emergency departments.

Researchers generally found no connection between the opening of retail clinics and visits to emergency departments for the low-acuity conditions, even when retail clinics began opening up near emergency departments.

The exception was among people with private insurance, where an extremely small drop in use of emergency department visits was detected. Even when patient access to retail clinics increased substantially in the area served by an emergency department, the reduction in emergency department visits for these conditions among the privately insured was less than 1 percent.

"Retail clinics may emerge as an important location for medical care to meet increasing demand as more people become insured under the Affordable Care Act," said co-author Dr. Ateev Mehrotra, an associate professor at the Harvard Medical School and an adjunct researcher at the RAND Corporation. "But contrary to our expectations, we found retail clinics do not appear to be leading to meaningful reductions in low-urgency visits to hospital emergency departments."

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Support for the study was provided by the federal Agency for Healthcare Research and Quality. Other authors of the study are Kathryn R. Fingar and Rosanna Coffey of Truven Health Analytics, Ryan Kandrack and Christine Eibner of RAND, Tom Charland of Merchant Medicine, and Anne Elixhauser and Claudia Steiner of the Agency for Healthcare Research and Quality.

RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.

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Warren Robak
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