The changing face of pharmacies in America: retail clinics

With the emergence of pharmacy retail clinics, the face of pharmacies and primary health care in America is changing. In this article, Aung Zaw Win from Notre Dame de Namur University in the United States describes how retail clinics, with their lower prices and the use of new technology, can provide a flexible quality healthcare service for minor ailments as well as chronic conditions.

The form and function of pharmacies in America are changing. Major pharmacies have already begun to reach beyond their traditional role as pill dispensers to meet new demands from patients. American retail pharmacy giants such as Walgreens, CVS, Wal-Mart, Rite Aid and Target are opening retail clinics: clinics located within a retail store. The co-location of retail clinics and pharmacies enables patients to fill their prescriptions at the same location. An estimated 10.6% of the total US population live within a five-minute driving distance of a retail clinic and 28.7% of the population live within a ten-minute driving distance. ¹

One example of a retail pharmacy clinic is ‘MinuteClinic’ by CVS. CVS has the highest number of retail clinics among the major pharmacy chains in America, with 970 MinuteClinics across the country employing nurse practitioners and physician assistants who can diagnose and treat certain medical conditions. ² Health services offered by the pharmacy clinics include treatment for minor illness, minor injuries and skin conditions; screenings and monitoring; wellness and physicals; routine lab tests; preventive care; patient education; and vaccinations. ³ Patients can use MinuteClinic for acute conditions such as pharyngitis as well as chronic conditions such as diabetes. Nurse practitioners in MinuteClinic will see patients as young as 18 months up to the elderly and can treat a variety of medical conditions. ² MinuteClinic offers several advantages over traditional health care:^3,4

Care at retail clinics is 30%−40% cheaper than similar care at physician offices and about 80% cheaper than similar care at emergency departments. ⁵ For health problems that develop after-hours, Americans have previously relied on emergency rooms, ⁶ leading to 55% of the 114 million visits to emergency rooms in a given year being for non-emergencies. ⁶ The US public as a whole can save approximately US$4.4 billion annually by visiting the retail clinics for certain conditions, instead of emergency departments. ⁷ Retail clinics have fixed prices for providing a particular treatment, for example, US$99 for flu symptoms, ² and the price can be less if the patient has health insurance. Acute unscheduled care accounts for about 30% of the 1.2 billion outpatient visits in the United Sates, far outpacing the capacity of the nation’s emergency departments. ⁸

Currently, more than 125 million Americans are currently living with a chronic medical condition. ⁶ Furthermore, there are more than 8.1 million undiagnosed diabetics in the United States. ⁹ Most of these patients are not receiving appropriate care from their physicians. ¹⁰ Diabetes – a debilitating chronic illness with an annual cost to the economy of US$174 billion – has a medication compliance rate of less than 50%. ⁶ Noncompliance reduces the effectiveness of medication regimens and can lead to acute episodes and complications. Retail pharmacy clinics have compliance programmes that can benefit patients and the health system. ⁶ A recent study showed that every US$1 spent on improving compliance returned US$7.10 for diabetes drugs, US$5.10 for cholesterol drugs and US$4 for blood pressure medication. ⁶ Pharmacy clinics can aid in early disease detection, chronic disease education and disease management.

There is currently a shortage of primary care physicians in America, although increasingly more Americans will have health insurance under the Affordable Care Act. This has lead to more than 35 million Americans living in areas underserved by physicians, according to government estimates. ⁶ Many patients have difficulty finding a physician for a traditional office visit. Retail pharmacies, however, have the potential to meet the demands of acute unscheduled care and fill the physician shortage gap. Retail pharmacy clinic use is increasing among people with health insurance. ⁵ The CVS MinuteClinic alone expects five to six million visits in 2015. ²

Up to now, MinuteClinics have formed partnerships and affiliations with hospitals, patient-centred medical homes and physician groups in 24 states of the United States. ³ One such partnership is between Cleveland Clinic and CVS. The nurse practitioners from the clinic communicate constantly with doctors so that it is easier for doctors in patient follow-ups. After a visit, the physician assistant sends a summary of the visit to the primary care doctor, with the patient’s permission. ³ The MinuteClinics are also connected to major healthcare systems in the country through the use of electronic medical records, ³ and doctors, in turn, offer advice in patient care. Hospital and clinic leaders have stated that retail clinics are helping to build a care continuum. ¹¹ There is also a growing relationship between retail pharmacy clinics and insurers (e.g. Blue Cross and Blue Shield) and third-party payers (e.g. Medicare). ¹² Parents prefer retail clinics for paediatric visits over the paediatricians’ offices. ¹³ One survey found that almost 50% of Americans would consider using a retail clinic. ¹⁴ For those who have already used a retail pharmacy clinic, 96% reported being satisfied or very satisfied with their care, ⁶ supporting the idea that MinuteClinics can deliver quality care to patients. ¹⁵ Experts predict continual growth and long-term viability of retail pharmacy clinics in America. ¹⁶

Finally, there is a pharmacy within 2.36 miles of all US consumers, so the number of pharmacy clinics is expandable. ⁶ Moreover, the Patient Protection and Affordable Care Act includes federal funding to support the development and operation of nurse-managed health clinics and funding for nurse practitioner training programmes. ¹⁷ Policy makers are aware of the value of pharmacy clinics to the health system, and this would increase the supply of nurse practitioners. Currently, MinuteClinics are implementing telemedicine programmes, which will allow nurse practitioners to see their patients through a computer screen ³ – a more cost-effective way to see patients. Furthermore, patients can see a health professional in the comfort of their homes, saving travel time and cost. Alternatively, patients can visit a retail pharmacy in person and sit at a kiosk in a private room to interact with a health professional via video chat. ³ The American Academy of Nurse Practitioners (AANP) stated that ‘retail clinics are a potentially viable resource for the provision of necessary primary care services in many communities throughout the United States’. Retail clinics are also making an impact on public health by increasing vaccination rates. ¹⁸ The future looks bright for pharmacy clinics – with the ability to take advantage of new technologies, their popularity is growing.