Oct 31, 2012
Published in: Journal of General Internal Medicine, v. 28, no. 4, Apr. 2013, p. 504-512
Posted on RAND.org on January 01, 2012
BACKGROUND: An increasing number of patients are visiting retail clinics for simple acute conditions. Physicians worry that visits to retail clinics will interfere with primary care relationships. No prior study has evaluated the impact of retail clinics on receipt of primary care. OBJECTIVE: To assess the association between retail clinic use and receipt of key primary care functions. DESIGN: We performed a retrospective cohort analysis using commercial insurance claims from 2007 to 2009. PATIENTS: We identified patients who had a visit for a simple acute condition in 2008, the "index visit". We divided these 127,358 patients into two cohorts according to the location of that index visit: primary care provider (PCP) versus retail clinic. MAIN MEASURES: We evaluated three functions of primary care: (1) where patients first sought care for subsequent simple acute conditions; (2) continuity of care using the Bice–Boxerman index; and (3) preventive care and diabetes management. Using a difference-in-differences approach, we compared care received in the 365 days following the index visit to care received in the 365 days prior, using propensity score weights to account for selection bias. KEY RESULTS: Visiting a retail clinic instead of a PCP for the index visit was associated with a 27.7 visits per 100 patients differential reduction (p < 0 .001) in subsequent PCP visits for new simple acute conditions. Visiting a retail clinic instead of a PCP was also associated with decreased subsequent continuity of care (10.9 percentage-point differential reduction in Bice–Boxerman index, p < 0 .001). There was no differential change between the cohorts in receipt of preventive care or diabetes management. CONCLUSIONS: Retail clinics may disrupt two aspects of primary care: whether patients go to a PCP first for new conditions and continuity of care. However, they do not negatively impact preventive care or diabetes management.