Pharmacy-Based Clinics Present Opportunities, Challenges in Primary Care

Andrew Kitchenman | March 7, 2014 | Health Care
Extended hours, lower prices are attracting patients, some without primary-care physicians of their own

CVS Pharmacy
Increasingly, people suffering from strep throat or the flu no longer need to visit their doctor’s office before heading to the pharmacy to fill a prescription — they can go straight to a clinic at the pharmacy.

The growth of these pharmacy-based clinics is being driven by the convenience of extended hours and often lower costs. Pharmacies themselves are eager to gain additional customers since they foresee a future in which demand for primary-care services overtaking the projected supply of doctors.

The trend received a booster shot yesterday with the opening of three clinics, in East Brunswick, Old Bridge, and Plainsboro. The facilities are run by CVS Caremark’s MinuteClinic retail healthcare division in collaboration with
Robert Wood Johnson University Hospital in New Brunswick.

The clinics are staffed by advanced practice nurses and can quickly schedule visits and are open longer hours. The nurses can diagnose, treat, and write prescriptions for common illnesses; give vaccinations; treat minor wounds and abrasions; provide wellness programs in areas like quitting smoking; and monitor chronic conditions such as diabetes and hypertension.

“From our perspective, it’s just an expansion of services into the community,” said hospital spokesman Peter Haigney. He said the hospital would be informing its patients about opportunities to receive care at the clinics, and would be offering health education through them.

While the pharmacy and hospital highlight convenience and advantages, the professional organization for New Jersey’s family physicians emphasize that patients should still depend primarily on doctors.

“The danger to it in my mind is that in the attempt to make the model convenient — which is a good thing — we could further fragment an already broken system,” said Raymond J. Saputelli, executive vice president of the New Jersey Academy of Family Physicians.

The academy’s national organization maintains that retail clinics can complement the care provided by doctors, but their scope of practice shouldn’t extend to managing chronic conditions. The group also notes that most doctor’s offices offer extended hours and same-day scheduling as part of their move toward patient-centered care, which may reduce the need for the clinics.

Saputelli added that the two-way relationship between doctors and patients is important in managing chronic conditions, like diabetes. “There’s always a chance that a conversation doesn’t take place with a physician,” because the patient is receiving care at a clinic, he said.

MinuteClinic New Jersey practice manager Anna Federico, an advanced practice nurse, described the clinics as a kind of “adjunct” to care patients receive in a primary-care office.

For example, while the clinics treat a wide variety of issues, their nurses will refer patients to doctors if they have any abdominal issues, such as a nausea or stomach pain.

But roughly half of all MinuteClinic patients don’t have established relationships with primary-care doctors, according to Federico. In cases where these patients need help, the advanced practice nurse will refer them to a list of local doctors.

The new facilities represent CVS’s fifth collaboration with a New Jersey hospital system to support some of its 31 clinics in the state. It also has agreements with Atlantic Health System, Barnabas Health, Hackensack University Health Network, and Virtua. CVS plans to open two or three more clinics in the state this year.

The cost for a standard visit is $79 to $89, although the clinics accept most major insurance plans in the state, as well as two Medicaid plans.

Most clinics have two examination rooms.

While details of the collaboration must still be worked out, Federico said the clinics would like to work with RWJ University Hospital on monitoring hospital patients with conditions like hypertension. The local referral lists will include many RWJ providers, but they would not exclusively be doctors from the hospital.

Haigney said the collaboration is an example of an increasing trend in which hospitals serve as resources for their communities, beyond the four walls of the hospital building.

“The goal isn’t to steer them anywhere. This can serve as a resource, to get them linked in to a primary-care provider,” Haigney said of patients.

CVS isn’t alone in offering such services. Walgreens has four of its Healthcare Clinic locations in southern New Jersey.