Youths in the Retail Health Clinic: The Numbers Are In

Practitioners who work in urgent care clinics (UCCs) and retail-based clinics (RBCs) know that they’re busier than ever and that they’re seeing many more patients than they were just 10 years ago.

Statisticians tend to look at ambulatory care visit data by patient demographics, and one population of interest in retail clinics is the young—pediatric, adolescent, and young adult populations.

UCCs provide convenient walk-in care and expanded hours on evenings or weekends, unlike many primary care practices. RBCs, usually co-located with high-traffic pharmacies or supermarkets, are also convenient.

The American Academy of Pediatrics has publically acknowledged that UCCs can improve children’s health and serve as care that augments the medical home or emergency department. Several other professional organizations, however, are more critical of RBCs for primary care, voicing concerns about care fragmentation, interference with the medical home, and quality of care.

A team of researchers from the University of Pennsylvania has examined UCC and RBC use as ambulatory care alternatives to physician offices in these young populations. Their study results appear in the January 2017 issue of theJournal of Adolescent Health, the official publication of the Society for Adolescent Medicine.¹

These researchers conducted a cross-sectional analysis of 8.9 million UCC, RBC, and physician office visits by privately insured American children aged 10 or younger, adolescents aged 11 to 18, and young adults aged 19 to 30 years. They gathered information about diagnoses and out-of-pocket (OOP) costs from January to June 2013.

A very small proportion of visits—fewer than 1 of every 20—was provided in UCCs and RBCs.

UCC and RBC providers were most likely to see patients from all 3 of these groups for upper respiratory infections. Youths with upper respiratory infections represented roughly 25% of diagnoses at UCCs and 38% to 42% of visits at RBCs.

At both UCCs and RBCs, otitis media was the second most common reason for a visit. At UCCs, fever ranked number 3, while at RBCs, immunization ranked number 3.

It was more costly for youths to be seen at UCCs—with OOP costs ranging from $25 to $38—than at RBCs, where OOP costs ranged from $4 to $18. In all cases, OOP costs were less than those at physicians’ offices.

Adolescents were more likely to be seen at a UCC or RBC than children were.

The researchers provide some possible explanations for their findings. They indicate that young adults are usually choosing their own care providers, as opposed to children, whose care is selected by their parents and who also have established relationships with pediatricians for immunizations and routine physical exams. Adolescents and young adults may be (1) uncomfortable visiting pediatric practices as they transition providers who care for adults, and (2) more cost sensitive.

Reference

1. Wong CA, Bain A, Polsky D, et al. The use and out-of-pocket cost of urgent care clinics and retail-based clinics by adolescents and young adults compared with children.J Adolesc Health.2017;60(1):107-112. doi: 10.1016/j.jadohealth.2016.09.009.