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Study: More Walk-In Clinics, Fewer ER Visits

AFTER A RETAIL CLINIC opens, people who live nearby are less likely to visit the emergency room for minor health issues like the flu, a new research letter suggests.

Retail clinics – health clinics located in stores such as Walgreens, CVS and Walmart – began offering basic primary care services like flu shots and diabetes monitoring on a walk-in basis in the early 2000s. The clinics usually have fixed prices and longer evening and weekend hours, and have been touted as a more convenient and affordable alternative to doctor's offices, urgent care and the ER for minor health issues. But they have also led to questions about their quality of care and whether they disrupt patient-doctor relationships.

For the new study, economists from the Federal Reserve Bank of Chicago, Princeton University and Northwestern University measured ER visits among people who lived within two miles of a retail clinic open at some point between 2006 and 2014 in New Jersey, to test whether having a retail clinic nearby affects where patients get treatment for preventable or controllable health issues like the flu, ear infections and diabetes.

"If a retail clinic opens nearby, some patients with minor illnesses and injuries should switch from the ER to the clinic because of its convenience and low cost," the economists theorized in a Chicago Fed letter summarizing the research. "In addition, more people should receive preventive primary care, thus reducing the number of ER visits."

Their findings indicate the retail clinic's effect depended on the health issue. The rate of ER visits fell by 13% for the flu, for example, while they declined 12% for sore throats and 10% for eye infections. Rates of emergency room visits for urinary tract infections, upper respiratory infections, ear infections, sprains and strains all declined by about 6%, while visits for diabetes fell by 3%, the researchers found.

Emergency room use didn't change for poisonings, bone fractures or births after a retail clinic opened, which the researchers said "adds confidence" to their finding that the clinics helped curb ER visits for "low-severity, treatable conditions," particularly preventable issues.

"These results suggest that improving access to primary care can reduce the number of patient visits at emergency rooms," the researchers wrote. "This, in turn, should have real cost savings, as the ER is an expensive place to receive care. … A flu shot is far cheaper than hospitalization for influenza."

The findings run counter to some previous research on retail clinics. The RAND Corporation, for example, found that while up to 20% of ER visits for non-emergency issues could take place at a retail clinic or urgent care center – saving as much as $4.4 billion annually – the availability of nearby retail clinics hasn't lead to a reduction in ER visits for these issues.

An analysis of nine studies on retail clinics published in September, meanwhile, concluded that the clinics are tied to lower costs, but that more research is needed on quality of care and patient satisfaction.

Part of the issue may stem from which patients have access to these clinics. In recent years, just 12.5% of retail clinics were in medically underserved areas, while most were in wealthier urban or suburban areas, according to RAND. In October, meanwhile, Walgreens announced it would shutter about 150 retail clinics by the end of the year.