Retail Clinics and Urgent Care Centers Offer Good Alternative to ER Visits

Retail clinics and urgent care centers could be a reasonable, cost-saving alternative for a large proportion of nonemergency conditions, a new study published inHealth Affairssuggests.

Although retail clinics, urgent care centers, and emergency departments are different, they share several relevant characteristics. Until now, there had been no detailed examinations of the overlap in care at the 3 sites, or the extent to which urgent cancer centers or retail clinics could substitute for emergency departments in providing nonemergency acute care.

To evaluate the differences, researchers compared patient demographics, medical conditions treated, and prescribed drugs at each of the sites for their study.

For retail clinics, investigators analyzed a prior study that invited leaders from all retail clinic companies to provide deidentified data on each visit that occurred from the inception of operations through the summer of 2008. A total of 8 companies provided data on 1.2 million visits.

For urgent care centers, information from 35 centers that used a common electronic health record specific to urgent care centers were used to collect data on visits that occurred between July 1, 2007, and December 31, 2007. Data for emergency department visits came from the 2006 National Hospital Ambulatory Medical Care Survey (NHAMCS).

Patients who were subsequently admitted to the hospital as being de facto inappropriate for care at a retail clinic or urgent care center were excluded from the study.

In order to determine the number of ER visits that could be treated in urgent care centers or retail clinics, researchers defined a set of diagnoses commonly treated in each of these settings. These were defined as health conditions that were seen at more than 2% of all visits at each site.

Researchers also calculated the amount of ER visits that occurred during typical retail clinic and urgent care center hours: 9 am to 9 pm Monday through Friday; 9 am to 5 pm Saturday; and 10 am to 5 pm on Sunday.

In regards to patients and visit characteristics, researchers found that for all 3 sites of care, a majority of visits were by females, and more than 40% were by adults between the ages of 18- and 44-years-old. Adults who were 65 and older accounted for a larger fraction of ER visits compared with retail clinics. Children under 2-years-old more frequently went to the ER than urgent care centers or retail clinics.

The results of the study revealed that about 17% of ER visits were made by patients who were uninsured compared with about 26% of visits to retail clinics.

Researchers found that the most common retail clinic diagnoses were for upper respiratory infections (60.6%), while preventative care, such as vaccinations or preventive exams, accounted for 21.6% of visits. Minor conditions such as allergies, conjunctivitis, rashes, and bug bites were comprised 9.5% of visits, and urinary tract infections were 3.7%.

In 2006, these 4 major groups of diagnoses accounted for more than 95% of all retail clinic visits.

Results showed that there were a wider range of conditions seen at urgent care centers than retail clinics. Although upper respiratory infections are common at urgent care centers, they constitute a smaller proportion of urgent care visits (33.3%) compared with retail clinics (60.6%).

Additionally, urgent care centers were found to see a decent proportion of visits related to musculoskeletal conditions (21.5%), such as joint and muscle pain, strains, fractures, and dermatological conditions (9.7%).

Compared with retail clinics (21.6%), both ER (3.8%) and urgent care centers (0%) were found to have significantly fewer visits for preventive services. For conditions that are not usually managed at urgent care centers or retail clinics, such as chest pain, almost 35% of visits to the ER accounted for this condition.

For prescriptions, more than 2 in 5 (41.5%) were written at urgent care centers for antibiotics and 14% were for pain medications. Opposite of this, researchers found that in ERs, 16.3% of administered or prescribed medications were for antibiotics and 38.8% for analgesics. No information was available for the study’s retail clinic data.

After examining the algorithms, the researchers found that a majority of visits for these common conditions could be managed outside the ER (range: 66.7-95.7%). Furthermore, only 9.7% of ER visits for chronic obstructive pulmonary disease and asthma could be managed outside the emergency department.

Researchers estimated that about 13.7% of all ER visits could be taken care of at a retail clinic. When the analyses were restricted to visits that only occurred during retail clinic open hours, they estimated that 7.9% of all ER visits could take place at a retail clinic.

For urgent care centers, researchers estimated that an additional 13.4% of ER visits could be seen at an urgent care center, and 8.9% when analyses were restricted to open hours.

The study showed that 27.1% of all ER visits could be managed at an urgent care or retail clinic, and 16.8% when the hours are restricted.

Authors noted that there were several limitations to the study: retail clinic and urgent care center data came from limited sets of providers; no available data on the proportion of trauma-related diagnoses that be treated outside of the ER, although researchers tested a range of assumptions to address this, it only partly mitigated in the analyses; and the inability to assess the distance between ERs that patients went to and retail clinics or urgent care centers.

The last limitation to the study was that estimated savings were predicted on 3 assumptions: that all eligible patients would move to alternative sites for nonemergency care; retail clinics and urgent care centers would have the capacity to provide care to an increasing number of patients; and that they captured the full range of services that could be provided at urgent care centers and retail clinics.

The authors concluded that if the increase in ER visits continues, it is likely to be unsustainable to the current health care system.