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Legal Liability in Convenient Care Clinics: Much Ado About Nothing
J Nurs Pract. 2008;4:773-775
During the past 5 years, a growing number of consumers have turned to convenient care retail clinics in their search for accessible, low-cost, quality healthcare. These clinics, often found in drug stores and discount shopping centers, are staffed primarily by nurse practitioners (NPs) who follow protocols to treat the most common primary care complaints and refer more complex problems to other providers. Convenient care clinics (CCC) have dramatically improved access to care for patients who have no insurance or who experience other barriers to healthcare. Not only are the clinics convenient, but they also allow patients to shop while waiting to be seen.
For the most part, CCCs have succeeded financially, although poor forecasting of patient demand, bad management decisions, and the declining economy have taken their toll on some clinics. In some settings where physician providers were added, increased operating costs were prohibitive to staying in business. NPs have accomplished the goal of providing care for nonurgent primary care concerns, and in doing so, they have decreased pressure on local emergency rooms that would otherwise see many of these patients.
Of all visits to CCCs, 90% involve 10 conditions: upper respiratory infections, sinusitis, bronchitis, pharyngitis, otitis media, otitis externa, conjunctivitis, urinary tract infections, and immunizations and screening tests or blood pressure checks. Most patients are seen by the provider within 15 to 20 minutes of computer registration into the system. For each chief complaint, there is a computer-generated protocol that the practitioner uses to diagnose and treat the patient. If the diagnosis falls outside the protocol, the patient is referred either to a local clinician who has agreed to work with the clinic or to the nearest emergency room, depending on the urgency of the problem. Each CCC also has a collaborating physician whom the NP can contact to discuss a particular case.
Clearly, the scope of practice in CCCs is narrower than the NP's preparation and education would ordinarily allow. But NPs choose to practice in these settings for a variety of reasons. Some like the independence afforded by the role, the hours, the benefits, the collegiality, or the ability to enhance their expertise with a limited number of conditions. Some NPs who have experienced the rapid pace of family practice clinics enjoy the extra time available in the CCC to offer needed education to the patient. With a limited number of conditions to treat, the NP encounters few obstacles to practice.
Not everyone has been happy about the CCC concept. Some organized medical groups have opposed CCCs, citing concerns related to continuity and coordination of care and lost revenue. As a new business delivery model, clinics have attracted the attention of researchers who have studied and refuted many of these concerns. Researchers have documented, for example, that there is little disruption of primary care relationships when patients seek care in CCCs. Most CCC patients do not have primary care providers (PCP), so there are few relationships to disrupt. Furthermore, most patients are 18 to 44 years of age, a group that otherwise would fail to seek care until more serious symptoms developed, increasing the costs of treatment.
Concerns about communication barriers between providers and patients have largely been resolved. All clinics either provide the patient with a written summary of the visit or fax a copy of the record to the patient's PCP. The financial impact from lost revenue is potentially offset by the PCP's ability to accept a greater number of complex cases whose reimbursement rates are higher than those of the simple acute cases handled in a CCC. The CCCs are also a potential source of referral of new patients whose health concerns fall outside the scope of services offered by the clinics.
In response to articulated concerns about CCCs, standards of care that address scope of service have been developed by the convenient care industry. For example, CCCs do not see children younger than 18 months of age. Electronic medical records provide ready access to visit summaries for PCPs, and all complex cases are referred to appropriate local healthcare providers.
The rapid expansion of CCCs into a variety of settings suggests that these clinics are here to stay and represent a unique way to offer affordable access to healthcare for underserved populations. As the number of physicians entering primary care declines, NPs have demonstrated that they can deliver this type of care, and the CCCs have become an excellent showcase for their skills and talents.
Nurses have long been valuable assets to their communities. This new healthcare delivery model puts NPs in settings where they may work closely with retail pharmacists to meet escalating patient needs for diagnosis and treatment of specific primary care problems in a fast and affordable manner.
Medscape Nurses © 2009 Medscape
Cite this: Convenient Care Clinics and the Nurse Practitioner - Medscape - Jan 20, 2009.