Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
BREAKING NEWS REGARDING RETAIL-BASED CLINICS AAP LEADERSHIP PRESENTS PEDIATRICIANS' CONCERNS ABOUT RETAIL-BASED CLINICS AT WAL-MART MEDICAL CLINIC SUMMIT Approximately 35 representatives from 10 different RBC companies met with Wal-Mart representatives July 25-26 at the Wal-Mart home offices in Bentonville, Arkansas. The group met to discuss issues such as legal issues as clinic tenants, media and outreach, the characteristics of a tenant agreement with Wal-Mart, marketing, and Wal-Mart’s health and wellness agenda. As part of this meeting, Wal-Mart invited the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Medical Association (AMA) to participate in a panel discussion with Wal-Mart and Retail-based Clinic representatives on July 26 th. The purpose of the panel discussion was to communicate each association’s position on Retail-based Clinics and to begin discussion as to how potential concerns could be addressed. A summary of this discussion follows. Presentation by the AAP Robert M Corwin, MD, FAAP, a former member of the AAP Board of Directors, represented the AAP on the panel. Dr Corwin focused on the AAP’s commitment of being “dedicated to the health of all children.” He stated that the Principles on Retail-based Clinic’s were currently undergoing legal review and would then need to be approved by the Board of Directors. Dr Corwin provided clarity that this was not a concern about working with nurse practitioners or physician assistants. Many pediatricians work very closely and collegially with nurse practitioners and physician assistants. The concern is related to the best model of care for children. Moving forward, Dr Corwin utilized the AAP Medical Home policy statement to outline the Academy’s concerns with the Retail-based Clinic model of care. He outlined the characteristics of care provided in the medical home model: accessible, continuous, comprehensive, coordinated, family-centered, compassionate, and culturally effective. Given the commitment to this model, the AAP is concerned that this Retail-based Clinic model – based on convenience – cannot be a substitute for the medical home model. Dr Corwin outlined specific concerns with the Retail-based Clinic model: The fragmentation of care at the medical home The potential effect on the quality of care provided at an Retailbased Clinic Children with special health care needs and chronic diseases, who may not be readily identifiable, receiving their care at an Retail-based Clinic The maintenance of a complete, accessible, central health record that contains all pertinent patient information The use of tests for the purposes of diagnosis without proper follow-up The possible public health issues that could arise when patients with contagious diseases are in a commercial, retail environment with little or no isolation (e.g., rashes, mumps, etc.) Finally, Dr Corwin noted that only seeing children with “minor conditions,” as many Retail-based Clinics indicate will be the case, is misleading and problematic. Many pediatricians utilize the opportunity of seeing the child for something “minor” to address issues in the family, catch up on immunizations, identify undetected illness, and continue strengthening the relationship with the child and family. These visits are not unimportant, but rather provide an opportunity to work with patients and deal with a variety of other issues. Dr Corwin closed by reminding the group that the Principles will be forthcoming after legal and Board review, and the AAP would be open to continued dialogue should further questions arise. Appropriateness of care in an Retail-based Clinic setting Dr Corwin responded to a specific question given to him regarding whether or not it was appropriate to use an Retail-based Clinic just to obtain a “quick diagnosis” when a pediatrician isn’t available for several days. He informed the group that most pediatricians are available on a same-day basis. He reiterated that the medical home is still the best primary care delivery system, especially for children. Techniques for winning the support of local physicians Dr Corwin commented that communication between practices and Retail-based Clinics has to be on a local basis. The AAP principles that are forthcoming will provide guidance to pediatricians as to how to respond to Retail-based Clinics. He also recommended that they talk to the pediatric societies (local, county, state) and family physician societies. How Retail-based Clinics gain the support of the 3 associations The AAFP reported that its Executive Committee is currently in the process of approving a memorandum of understanding (MOA) this week that the AAFP would then use to partner with an Retail-based Clinic. The AAFP reiterated that it has published “attributes” and not “guidelines,” but affirmed that it would endorse a Retail-based Clinic that met the AAFP’s published attributes. They wanted to continue working with Retail-based Clinics and others to achieve healthcare coverage for all and increasing the number of primary care providers. The AMA reiterated its interest in working with Retail-based Clinics on the AMA’s advocacy agenda, focusing on issues such as medical liability reform, Medicare physician payment reform, expanding coverage for the uninsured, improving public health, and patient safety and quality improvement. Dr Corwin maintained the stance that the AAP could not endorse Retail-based Clinics as a best model of care for children. The medical home model is the best model of care. Some of the Retail-based Clinic models that are physician staffed and more comprehensive indicated they were committed to being a medical home. Dr Corwin noted that this is a different model than other Retail-based Clinics that very limited in scope and staffed only by nurse practitioners. He reiterated that once the AAP principles are published, the Academy would be willing to hold ongoing discussions to further clarify its stance, should questions still exist. At least 2 of the Retail-based Clinics indicated that the concerns of the AAP should be taken into consideration. FINAL COMMENTS Dr Corwin was able to capture the interest of the group by stating that the Retail-based Clinic model is not an appropriate model to provide medical care to any child. He emphasized that children are different – they are not “mini adults.” This requires a different model of care and it is the AAP’s opinion that the medical home model is the best practice.