Pharmacy clinics drawing skeptics, customers

June 2, 2013 at 12:00a.m.

Palm Beach Post

When Akim Reid needed a physical for his job, he couldn’t turn to his regular doctor — he doesn’t have one. The Loxahatchee, Fla., resident called around for someone to do the exam. Everyone he called could see him — next month.

So he went online for a clinic that could take him on short notice. He found one — his local pharmacy.

Wendy Sparapani has a pediatrician for her 16-year-old son Justin. But when Justin’s persistent cough became overwhelming, she didn’t even bother with the doctor’s office. A pharmacy close to her Jupiter, Fla., home could see him in minutes.

In the past decade, millions of Americans each year have skipped the doctor’s office or emergency room and headed to a pharmacy for everything from a flu shot to treatment for strep throat.

The nation’s largest drugstore chain, Walgreens, recently announced that staff at its 360 clinics can assess, treat and manage more chronic illnesses such as asthma and diabetes.

Meanwhile CVS, where Reid and Sparapani sought help, boasts 640 Minute Clinics in the U.S. with plans to have 1,500 by 2017.

All these clinics are staffed by either nurse practitioners or physicians’ assistants. Both can write prescriptions and have advanced degrees.

The clinics are clearly meeting a public demand — one that is forecast to grow as the population ages and the Affordable Care Act extends insurance to another 34 million people. A survey published in January indicates that more than one-quarter of Americans have been to one of these clinics in the past two years. They cite convenience — no appointments, short waits and extended hours — as reasons.

Three-quarters of them had health insurance.

Some doctors fear this expansion poses a health threat to the people treated.

Instead of having a “medical home” where a physician knows the patient’s history, more patients will be leaving pieces of their medical histories scattered about town in various pharmacies.

“What about your mammograms, what about your diet or mental health? They’re going to take care of parts. They aren’t going to provide comprehensive medical care,” said Dr. Jeffrey Cain, president of the American Academy of Family Physicians, who practices in Denver.

Dr. Cain and the academy do not write off pharmacy clinics entirely.

“If they’re doing it in collaboration with a primary-care physician, sharing lab results and information that could enhance their care. But how do you make sure that happens?” asked Dr. Cain.

West Palm Beach, Fla., internist Daniel Fortier gives the retail clinics a mixed review.

It’s often better for a patient to go to a pharmacy than clog the hospital emergency room, he said.

“You need more ways to get care,” Dr. Fortier said. “For the most part, I think it’s going to increase that access to care.”

But when pharmacy clinics take on the treatment of more chronic conditions such as hypertension or diabetes, Dr. Fortier worries that they are taking on too much.

Donna Shalala, who headed the Department of Health and Human Services in the Clinton administration and is president of the University of Miami, wants to see medical professionals more often at their full abilities, and pharmacy clinics give them that chance, she said.