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Drugstore Clinics Aren't Best for Sick Kids, Doctors Say

<p>A pediatricians group says drugstore health clinics aren't best for sick kids.</p>
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Taking a sick kid to a drugstore health clinic might be easier — and even cheaper — than going to the doctor’s office, but an influential pediatricians group is warning parents that such sites don’t provide the regular, high-quality care that children need.

Retail-based clinics are an “inappropriate source of primary care,” according to the American Academy of Pediatrics, which on Monday reiterated that it hasn’t budged on its 2006 stance, despite an explosion of sites at places like Walgreens and CVS.

Such clinics can lead to “fragmented” care offered by mid-level medical providers — usually nurse practitioners — who are not specifically trained in pediatrics, said Dr. James J. Laughlin, a Bloomington, Ind., pediatrician who is the lead author of the updated policy.

“The AAP strongly feels that the medical home model of care for kids is best,” Lauglin said."Unless the retail-based clinics are willing to work collaboratively with us, then it's not going to be helpful."

But the firms that run most of the at least 1,600 retail health clinics nationwide say they do work with doctors, not against them, to provide quality care for low-level health problems like ear infections and strep throat. The American Nurses Association says that studies have consistently shown that nurse practitioners offer high-quality care in the clinic settings.

“The latest policy statement from the American Academy of Pediatrics is just another attempt to preserve the status quo,” the ANA said in a statement.

And parents say they rely on the clinics that are open after work and on weekends — when most doctors’ offices aren’t.

“If I want to see my children’s pediatrician, there’s no way I’m going to go there and see him that day or the next day,” said Karin Ide, 46, of Park Ridge, Ill., who has taken her two boys, ages 6 and 7, to Walgreens clinics for care.

“If they have flu symptoms or a sore throat or someone has an ear infection and I feel like I need to get them in really quickly, I’ll go,” said Ide, a single mother who juggles kids and her job at a large local bank.

Officials with CVS, which runs 815 MinuteClinics in 28 states, and Walgreens, which operates 400 retail health clinics, say they follow evidence-based guidelines for children’s care and provide follow-up reports of clinic visits to the regular pediatrician.

“We believe in the primary care medical home and we’re supportive of it,” Dr. Andrew Sussman, president of CVS MinuteClinic, told NBC News. “We believe we can play an important and complementary role.”

The CVS clinics have relationships with 30 major health systems nationwide and are helping to ease an ongoing shortage of primary care doctors, added Sussman, who is the associate medical director for CVS Caremark.

A clinic visit may also be less expensive than a trip to the pediatrician, according to a 2009 study that found that retail clinic costs ran 40 percent to 80 percent lower than the same visits to doctor’s offices, urgent cares or emergency rooms.

That same study, conducted by RAND Health researchers and published in the Annals of Internal Medicine, found that the quality of care was just as good at the retail clinics as at the other venues.

CVS launched the first retail health clinic in Minnesota in 2000. The Convenient Care Association, a trade group, says there are about 1,600 clinics nationwide, but the AAP estimated there were about 6,000 as of 2012. About 20 million clients have been seen since then, the CCA said. Between 15 percent and 20 percent have been children, though the clinics typically see patients older than 18 months, leaving infant care to pediatricians.

The AAP, however, said there are still concerns about the quality of care, about coordinating health records and about whether what appear to be minor conditions may actually mask larger problems that could be missed by staff in a busy retail clinic.

“I feel like I can be a better doctor for my patients if I’m seeing them for a gamut of illnesses,” said Laughlin, who noted that he often uses visits for minor ailments to check on other potential problems.

But CVS officials point to the case of Camie Brown, a high school basketball player who needed a sports physical in October 2012. Natalie Babcock, a nurse practitioner at a CVS MinuteClinic in Chesterton, Ind., heard a heart murmur that other doctors had missed, potentially saving the girl’s life.

“It’s just a blessing that Natalie was a skilled practitioner who knew what she was doing,” said Camie’s mom, Sophie Brown, 45, of Valparaiso, Ind.

“You could say we’re fighting a turf battle, but you could also say they’re cherry-picking.”

Laughlin dismissed suggestions that the retail clinics are draining customers from traditional doctors or that there’s a turf war going on over who cares for mild childhood illnesses.

“You could say we’re fighting a turf battle, but you could also say they’re cherry-picking,” Laughlin said.

If parents take their kids to quick clinics, they should ask that their records be forwarded to the regular doctor to ensure continuity of care, Laughlin said.

For their part, the retailers agree. “We strongly encourage all patients to have a relationship with a primary care physician and medical home for ongoing medical needs and routine exams,” Walgreens officials said in a statement.

That makes sense to Karin Ide, the Illinois mom who relies on retail clinics after hours but still sees traditional doctors as well.

“I do use them a lot, but there are definitely other things that I want to see my primary care physician for,” she said. “It’s not like I’m going to use Walgreens for everything.”