Comparing Costs and Quality of Care at Retail Clinics With Those of Other Medical Settings
Authors: Rajan Kochar
Journal: Annals of Internal Medicine (2010)

Letters16 February 2010Comparing Costs and Quality of Care at Retail Clinics With Those of Other Medical SettingsRajan Kochar, MD, MPHRajan Kochar, MD, MPHFrom University of Texas Health Science Center at Houston, Houston, TX 77030.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-4-201002160-00019 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I read the article by Mehrotra and colleagues (1) with great interest; however, I do have some concerns. First, the study compares episodes in patients who were first seen in different clinical settings (retail clinic, physician office, urgent care clinic, and emergency department). Patients may not have received care in the same clinical setting throughout the episode. Although the authors mention that the percentages of episodes with any follow-up visits were similar for retail clinics, urgent care centers, and physician offices and higher for emergency departments, we do not have information on the number of follow-up visits or the clinical settings in which they were conducted. Several patients who were first seen in retail clinics may have received follow-up in urgent care clinics or physician offices. Therefore, the quality-of-care measures and preventive services attributed to retail clinics could have been due to follow-up in other clinical settings.Second, the study participants were matched by diagnosis codes but not by severity of symptoms, leading to a high likelihood of selection bias. It is possible that patients who initially visited a retail clinic had less-severe illness, and most may not have required laboratory testing or prescription medications. The overall cost for these patients may have been even lower if they were first seen in an urgent care clinic or a physician's office, because the higher cost of evaluation in these settings would be balanced by the money saved on unnecessary laboratory testing and medications.Finally, the authors matched the study participants by income category but not by race or geographic location. Retail clinics are more likely to be present in areas with higher median income and lower population percentage of black persons and are less likely to exist in medically underserved areas (2). Therefore, the population served by the retail clinics may differ significantly from that served by urgent care clinics and physician offices, even though all patients had the same health plan.Rajan Kochar, MD, MPHUniversity of Texas Health Science Center at HoustonHouston, TX 77030References1. Mehrotra A, Liu H, Adams JL, Wang MC, Lave JR, Thygeson NM, et al. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Ann Intern Med. 2009;151:321-8. [PMID: 19721020] LinkGoogle Scholar2. Pollack CE, Armstrong K. The geographic accessibility of retail clinics for underserved populations. Arch Intern Med. 2009;169:945-9; discussion 950-3. [PMID: 19468086] Google Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From University of Texas Health Science Center at Houston, Houston, TX 77030.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses Ateev Mehrotra , Hangsheng Liu , John L. Adams , Margaret C. Wang , Judith R. Lave , N. Marcus Thygeson , Leif I. Solberg , and Elizabeth A. McGlynn Comparing Costs and Quality of Care at Retail Clinics With Those of Other Medical Settings Richard A. Young Comparing Costs and Quality of Care at Retail Clinics With Those of Other Medical Settings James R. Johnson Comparing Costs and Quality of Care at Retail Clinics With Those of Other Medical Settings Ateev Mehrotra , N. Marcus Thygeson , and Elizabeth A. McGlynn Metrics Cited byCost and Utilization of Retail Clinics vs. Other Providers for Treatment of Pediatric Acute Otitis MediaFrom the bedside to the community: Comparative effectiveness, health services, and implementation research 16 February 2010Volume 152, Issue 4Page: 266KeywordsConflicts of interestGeographic areasHealth care qualityResearch laboratories ePublished: 16 February 2010 Issue Published: 16 February 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...