Healthcare 311 NewsNews & notes on convenient care, from Healthcare 311

What to say about the popular press accounts (such as this one, in the 9/7/10 New York Times) of a new study of acute care treatment published in the current issue of Health Affairs (Stephen R. Pitts, et al, Where Americans Get Acute Care: Increasingly, It’s Not At Their Doctor’s Office. Health Affairs, September 2010) ?

The options are numerous:

• Primary care is broken, and the study simply quantifies what has been known for years;
• Primary care is broken, and the study highlights looming challenges for the implementation of effective health system reform in accord with new Federal legislation;
• Primary care is broken, and the study provides a needed platform for outlining effective primary care delivery alternatives

You may discern a theme here, dear reader…

The difficulty is that appropriate conclusions are not self-evident. Is educating ER users about more-appropriate treatment venues the best fix? Perhaps hospitals could solve the problem with relatively simple adjustments to their EMTALA obligations? Surely the nation’s policies regarding EMR/PHR adoption can play a positive role in channeling individuals to the most appropriate care settings for their health conditions? And of course we can’t forget the possibility that a combination of these and other approaches might yield valuable improvements….

Our initial feeling is that close examination of decisions about where to obtain acute care treatment would be well worth the time and trouble. People get care where they get care for reasons, and we imagine those reasons are at once practical, malleable. and deeply affected by both ingrained habits and available information about alternatives.

When we undertake to make people’s care-consumption decisions better for them and for our health care system, we’lll do better by looking at what people actually do rather than go by practitioner beliefs/desires regarding what people should do.

The retail clinics news items of recent days, while worthy of note, are fairly workaday: Drug Store News runs a report of Kroger’s sole ownership of The Little Clinic (April 5); Take Care Health is reported to open an onsite clinic at a Buffalo, NY Toyota plant (April 9); The Gloucester County (NJ) Times profiles Drexel University’s new walk-in health center in Philadelphia (April 9).

So we were delighted to come across a less-easily-classified article in the journal Preventing Chronic Disease, first published over a year ago (March 2009) by the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and picked up just this week for some reason by the UK version of NIH’s PubMed Central.

The article, written by then-independent consultant Eileen Salinsky (she’s now Program Advisor for Grantmakers In Health) on behalf of AARP’s Office of the CEO (though it is accompanied by the all-encompassing disclaimer, apparently provided by UK PubMed Central, that “[t]he opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions”) bears the alluring title Medicine, Big Business, and Public Health: Wake Up and Smell the Starbucks. In it, the author deftly outlines the current dynamics of the historically fraught relationship between public health and “commercial” medicine, including of course in the new dynamic the emergence of retail clinics:

Some worry that time-tested collaborative endeavors [between public health entities and medical care providers) are growing strained as corporate interests increasingly drive practices and priorities in the health care industry. This corporatization is perhaps most vividly demonstrated by the small but growing presence of major retailers in the provision of ambulatory care.

We especially like the author’s observations on the use of IT in retail clinics and workforce competencies:

on IT in retail clinics
To maintain an acute awareness of consumer preferences, retail businesses invest substantial resources in information technology and data-gathering activities….these consumer monitoring techniques (such as customer surveys, focus groups, purchasing profiles, and frequent shopper programs) also have the potential to provide valuable information for public health research and practice.

Public health has begun piloting methods to use consumer product data for syndromic surveillance. Additional forms of data sharing and collaborative monitoring hold tremendous promise.

on workforce competencies

Retail clinics are typically staffed by nurse practitioners, and clinic operators have noted that the quality and communication skills of the clinical staff are central to achieving consumer satisfaction. The premium placed on employing highly competent clinicians with superior interpersonal skills suggests that these retail clinic employees could be valuable allies in disseminating disease prevention and health promotion messages.