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.

UPDATE: WalMart has also recently opened a new clinic in Palmyra, ME – it’s 100th retail clinic, according to available news stories.

Target has made few changes in its clinics mix in the past few years. The five new Chicago clinics will bring their total to 36 – a large move percentagewise, but not one that will vault Target into the ranks of the leading clinic operators, CVS (MinuteClinic), Walgreens (Take Care Health), Kroger (The Little Clinic), or WalMart.

Flu Shots Your Way

Or Target’s since-discontinued online clinic visit scheduler.

My sense is that Target took down its online scheduling application due to lack of use – but why not make it available, even if it’s seldom used? Its very availability suggests that Target has its would-be clinic visitors’ ease & convenience in mind. I suppose it raises issues for onsite juggling of onsite walk-in customers – who may be unaware of clinic scheduling options – and those in the know who HAVE scheduled visits.

Management of customer perceptions of ‘privilege’ is not insignificant, but may be enough, combine with low use, to make mothballing scheduling the right move.

Can anyone help clarify this for me?

Exceptional Patient Experience Delivered at Take Care Clinics at Select Walgreens

Take Care Clinic strongly engages more than 3-out-of-every-4. The typical company in Gallup’s database strongly engages less than 1-in-5 of their customers.

“In today’s consumer-driven healthcare environment, engaging patients is far more powerful than simply satisfying a patient. Not only is satisfaction a poor indicator of future behavior, but more importantly engagement may be predictive of a patient’s willingness to make changes necessary to improve their health,” said John Fleming, Gallup principal and chief scientist customer engagement….

“Take Care Clinic believes that an engaged patient leads to better adherence,” said [ Sandra F. Ryan, RN, MSN, CPNP, FAANP and Chief Nurse Practitioner Officer for Take Care Health Systems]. “If a patient believes in the provider who is giving the advice, they are more likely to follow the treatment protocol that has been put together. This includes taking medication as prescribed, seeking follow-up care or making a lifestyle change. The patient is also more likely to return to a Take Care Clinic because of the great experience and care received.”

Before we continue – who knew you could grow up to be a customer engagement scientist? Sounds cool.

We understand Take Care Health’s and Gallup’s enthusiasm for the kind of customer engagement Take Care clinics are generating. What we don’t understand is this: given retail clinics’ focus on episodic care, and their explicit public commitment to supporting customers’ development and/or maintenance of relationships with primary care physicians, shouldn’t ‘scoring’ engagement success based on actual customer return visits be viewed as ambiguous at best? (We can set aside that, as a practical matter, Take Care will have a tough job gathering objective evidence that customers have in fact followed through on care recommendations from their Take Care visits).

The Role of Retail Clinics Post-Health Reform (HealthPopuli, 8/22/10)

More Research Needed on Role of Retail Clinics: Study (Healthcare Financial News, Healthcare Financial Management Association, 8/23/10)

and they’re as devoid of surprise as the report itself. Which is probably par for the course for any report released in mid-August.

They’re also prone to substitute their own implications for the frankly cautious implications identified in the report itself. Again, little surprise there.

McMedical Care |The rise of health clinics in retail stores could affect both health policy and regulation

http://www.governing.com/topics/health-human-services/McMedical-Care.html

was published in Governing in 2006, so it could not have been informed by the recent white paper on clinics and public policy released by Rand, & written by Dr. Ateev Mehrotra and colleagues which we posted about yesterday. We did not see it in 2006 – a link to the article showed up in our mail just yesterday – so we took heed of the serendipity & decided to reference it here.

At very least it makes a nice complement to that more recent publication, providing a historical point of reference for the early & modest research findings summarized in the Rand paper.

Policy Implications of the Use of Retail Clinics. August 2010. Authors: Robin M. Weinick, Craig Evan Pollack, Michael P. Fisher, Emily M. Gillen, Ateev Mehrotra.

We haven’t yet seen any media releases for it, and thought you’d like to know about it.

Dr. Mehrotra can lay claim to being the most recognizable retail clinics expert among clinicians and academics.

We’re poring over the report as you read this. Watch for our review in the next few days.

I don’t believe so, and I don’t think the facts Ken points to in his brief article make his case, but alas – I have not marshalled the countervailing facts that impel me to disbelieve his assertion. I hope to, but it won’t happen today.

We remind you, dear reader, of our principal theme to give you context for our posting the following links to two otherwise apparently unrelated health care topics, both identified by their authors or editors as about “mobile health”:

Mobile Clinics Seen As A Way To Cut US Health Bill (Scott Malone, Reuters, 8/11/10; immediate access)

The [Family Van] — which visits six low-income neighborhoods around Boston weekly — is one of about 2,000 such mobile clinics in the United States. Advocates say the approach can help control the rising cost of health care by helping people with chronic diseases to stay out of the emergency room, often the first recourse for inner-city residents.

Mobile Health and the FDA: What WellDoc’s Approval Means for mHealth (Jane Sarasohn-Kahn, HealthPopuli, 8/10/10; immediate access)

While an “N” of 1 = 1, and WellDoc’s approval is for one product from one company, the approval of DiabetesManager represents a positive sign for the many developers of mobile health applications waiting in the wings for market approval.

We’re confident that your familiarity with Healthcare 311 would equip you to advise those authors & editors that their subjects are also squarely in the realm of “convenient health”.

Because they are.