Comparing Costs and Quality of Care at Retail Clinics With Those of Other Medical Settings

Abstract

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 77030