April 14, 2011
Pharmacy clinics or retail based clinics (RBC’s) are popping up all over the area. Cheshire, North Haven, and Hamden have all become host to these clinics, which can be enticing at first glance. They are inexpensive, convenient, and can fill a prescription on the spot. So what’s the downside to this one stop shopping?
An actual PMA story: A teenager is seen at a local Pharmacy Clinic. The clinician there obtains an incomplete medical history and misses, among other things, that the patient has a penicillin allergy and a history of asthma. The patient’s cough is treated as a Strep bacterial infection even though his culture is negative. He is sent home with a prescription for penicillin, the same antibiotic he has a known allergy to. The clinic bills his insurance for the visit.
Primary care clinicians are becoming all too aware of the problems associated with RBC’s. First and foremost is lack of continuity. Because they don’t maintain patient charts, they are often missing important pieces of the patient’s medical history. The RBC staff provides poor (if any) communication with the primary care doc, they have limited (if any) ability to be reached by phone with questions, and they rarely (if ever) see a patient in follow-up.
A 5 year old patient has a reaction to a medicine that was prescribed at an RBC. The parent calls back for advice and is told that the RBC’s don’t deal with “those types of problems.”
Yes, the RBC’s can turn away any complaint they think might be too complicated or take too much time. And that includes follow-up for an issue they have already dealt with. But how can you predict that as a parent?
An 8 year old patient was recently evaluated for sore throat at an RBC. A negative quick strep was performed, but no overnight culture was sent off (a national standard of care). In the patient note was documented, “Patient refused overnight throat culture.”
I asked the parent if they had truly refused this and the patient answered, “Why would I ever refuse that?!” Considering the fact that the quick test is not totally accurate and that untreated strep can cause permanent heart disease as well as other serious complications, this is not a minor oversight. “I thought anybody could evaluate a sore throat!” said the parent.
Another issue is lack of pediatric specific training and supervision. Kids just aren’t small adults. Kids have very unique and special issues. For instance, did you know that a child presenting with sinus infection doesn’t complain of facial pain like an adult would? She has ongoing nasal drainage and cough! The typical RBC clinician has minimal pediatric experience, and no access to a supervising pediatric-trained clinician to discuss cases with.In contrast, when you see a clinician at PMA, you are getting the benefit of our team’s accumulated experience, a combined century—over 100 years—of clinical pediatric experience!
So the next time you consider visiting an RBC, think twice. The American Academy of Pediatrics (AAP) is a strong opponent of RBC’s. And the AAP believes that all children should have a “medical home.” That is, a single place where a child’s health care is centered and delivered. Please check out the following link:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/6/2561
So remember, there are lots of good reasons you’ve chosen PMA as your child’s medical home. At PMA, we know you and your child. We’re there for you 24/7, weekends, holidays and evenings—even for those “silly” questions. We have the experience and specialty training to care for your child. We practice quality pediatric specialty care. And we have for generations.