Parents who had established relationships with pediatricians still accessed care for their children at retail clinics (RCs), typically located in large chain drugstores, mostly because the clinics were convenient, according to a study published by JAMA Pediatrics, a JAMA Network publication.
Most RCs are staffed by nonpediatric nurse practitioners and physician assistants who care for patients 18 months and older with minor illnesses such as ear and throat infections. However, the literature regarding RCs is limited and little is known about the use of RCs for pediatric care, according to the study background.
Jane M. Garbutt, M.B., Ch.B., of Washington University School of Medicine, St. Louis, and colleagues sought to determine reasons parents with established relationships with pediatricians used RCs for care for their children.
The study at 19 pediatric practices in a Midwestern practice-based research network included 1,484 parents (a 91.9 percent response rate) who completed a survey.
Of the 344 parents (23.2 percent) who had used RCs for their children, 74 percent first considered going to the pediatrician, but reported choosing an RC because the RC had more convenient hours (36.6 percent), no office appointment was available (25.2 percent), they did not want to bother their pediatrician after hours (15.4 percent) or they thought the problem was not serious enough (13 percent). Visits (n=344) to RCs were most commonly for acute upper respiratory tract illnesses (sore throat, 34.3 percent; ear infection, 26.2 percent; and colds or flu, 19.2 percent), according to the study results.
"Many parents with established relationships with a pediatrician use RCs for themselves and for their children, with some repeatedly choosing the RC instead of an office visit. These parents believe RCs provide better access to timely care at hours convenient to the family's schedule," the study concludes. "Pediatricians can address concerns about quality of care, duplication of services and disrupted care coordination by working to optimize communication with the RCs themselves, as well as with their patients regarding appropriate management of acute minor illnesses and the role of RCs. They also will need to directly address parents' need for convenient access to care."
Editorial: Public Preferences, Professional Choices on Retail-Based Clinics
In an editorial, Edward L. Schor, M.D., of the Lucille Packard Foundation for Children's Health, Palo Alto, Calif., writes: "In this issue of JAMA Pediatrics, Garbutt and colleagues try to understand and reconcile parents' use of highly accessible and low-cost retail-based clinics (RBCs) for their children with the position of the American Academy of Pediatrics that children's care should occur in their medical home."
"Pediatricians seem to be taking the threat of RBCs with a grain of salt," Schor continues.
"Retail-based clinics reflect systemic changes occurring within the health care industry to which pediatric practices must adapt," Schor concludes.
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