Docs oppose retail-based clinics for kids' care

• The AAP policy statement opposes the use of retail-based clinics for kids%27 regular health care
• Pediatricians say their expertise and the medical home should be the standard of care
• There are just over 1%2C600 retail-based clinics in 39 states and the District of Columbia

Families often turn to retail-based health clinics such as CVS' MinuteClinic, Walgreens' Healthcare Clinic or Kroger's The Little Clinic when a child is sick or needs shots. But the nation's largest group of pediatricians opposes such facilities for children's primary care, saying they do not provide the high-quality, coordinated preventive health care kids need.

In an update to its 2006 policy statement, released Monday, the American Academy of Pediatrics says that retail-based clinics (RBCs) are "an inappropriate source of primary care for pediatric patients, as they fragment medical care and are detrimental to the medical home concept of longitudinal and coordinated care." A medical home refers to a central provider who coordinates a child's medical care.

Although the basic message and stand from the academy have not changed since the 2006 statement, "the number of clinics has grown and they are used much more," says pediatrician James Laughlin, lead author of the statement and medical director for pediatrics at IU Health in Bloomington, Ind.

"If these entities are going to take care of children, there should be certain standards adhered to in terms of communicating back to the pediatrician or having some sort of relationship with a pediatrician locally so that a child can be referred back to their pediatrician for ongoing care."

Continuity of care is of particular concern because a child may be seen in a clinic earlier in the day, but if a related situation arises late in the evening or during a clinic's off-hours, "they traditionally don't have any kind of after-hours availability," says Laughlin, adding that AAP encourages its members to provide accessible hours and locations as part of a medical home.

Filling a gap when a child's pediatrician is unavailable is a primary service provided by the clinics, says Tine Hansen-Turton, executive director of the Convenience Care Association, the trade group representing the clinics.

"They are a more convenient option for parents with sick children rather than the alternative, which is often waiting for an appointment while the child is sick or spending hours in a high-cost emergency room for a minor pediatric complaint."

Unlike free-standing urgent care clinics, RBCs are located within stores, almost exclusively use nurse practitioners or physician assistants to provide care, and offer a limited range of services.

Currently, there are just over 1,600 RBCs in 39 states and the District of Columbia that have served more than 20 million consumers to date including children, according to Hansen-Turton.

About 20% of the patients seen at MinuteClinic are children, says Andrew Sussman, president of the largest chain of retail-based medical clinics in the U.S. with 815 clinics in 28 states and the District of Columbia. It expects to add 150 new clinics this year.

"MinuteClinic adheres to the principles (the AAP) outlines," says Sussman, a physician who previously practiced internal medicine. "We are very supportive of the medical home and the important role that the pediatrician plays, and we really see ourselves as complementary and supportive of that role."

He notes, for example that it uses evidence-based guidelines when determining what care to provide, automatically provides parents of pediatric patients with a list of pediatrician referrals if they don't have a medical home, and, with the parent's permission, sends a note about the care it provided back to the family pediatrician.

"Increasingly that's done electronically," says Sussman, adding that it has official clinical affiliations with 30 major health systems across the country, including UCLA Health, Cleveland Clinic and Emory Healthcare.

"We agree that the pediatrician should be the quarterback of the team, but we also think there's an important role for walk-in-care that's low cost and evidence-based," he says.

Finances are addressed in the AAP statement, which notes the importance of the medical home in ensuring "that pediatricians and other primary care physicians receive adequate compensation for the continuous, coordinated, and comprehensive health care that they provide."

"It's important to recognize the expertise of pediatricians, because that's what they do 100% of the time," says Laughlin. "I think there are instances where it is reasonable to use a retail-based clinic, such as if you're traveling or if you have a time crunch and you feel like that's where you need to go to get immediate care. But make sure that the information from that visit gets transmitted back to your pediatrician because the medical home is the optimal standard of care for pediatric patients," he says.