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21 Surprising Ways Wal-Mart Clinics Will Affect US Healthcare

Jessica Hupp at RN Central writes a thought provoking article titled 20 Surprising Ways Wal-Mart Clinics Will Affect US Healthcare.

#20 is “Decreased Continuity of Care”.  I think this one is debatable, and I’ll offer as #21 “Increased Continuity of Care”.  

Jessica writes:

With traditional doctors, patients have charts and medical records, but at in-store clinics, diagnosis is a one-off deal. Problems that could be caught over multiple visits and diagnosis could go unearthed unless the patient works to inform practitioners.

I’m picking up on a split in the thinking of companies running the retail clinics.

  • Indeed, some do seem to have a mindset of competing directly with primary care physicians and NOT having processes to refer patients back to their medical home or family doctor.  I expect that over time some retail clinics will get more directly involved in disease management programs, and perhaps include that as a major selling point.
  • Others, e.g., MinuteClinic, are much more in tune with their role in a continuum of care.  They refer patients back to their medical home, help patients get established with an ongoing medical home if they don’t already have one, and send information about the visit back to the patient’s doctor using the Continuity of Care Record (CCR) Standard.

I think the jury is still out on whether retail clinics will help or hurt the continuum of care.

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5 Comments

  1. Steve Hards on February 29, 2008 at 8:31 am

    I assume (from my observation of supermarket developments in the UK) that WalMart also sells pharmaceuticals and possibly some ‘aids to daily living’. In which case, the provision of doctors’ services neatly completes a cross-selling triangle of products. With the introduction of remote health monitoring equipment into the stores it will be interesting to see whether WalMart also provides the actual monitoring, in which case there will be increased continuity of care for those customers.



  2. Joseph Kvedar on March 1, 2008 at 9:17 am

    I agree, Vince, that it could go either way re: fragmentation of care. In the early days, it is likely to be more on the fragmented side, because physicians are more likely to the historic view, ‘If its not in my record, I don’t know about it”. This may lead to repeating tests, etc. and some confusion. However, if Walmart could, as you suggest, take the lead in providing electronic, standards-based records of their in-store transactions and make it easy for consumers to get those in the hands of their doctors, it should both increase continuity of care and provide a model for how electronic information flow between disparate systems might work.



  3. Dave Moskowitz MD FACP on March 7, 2008 at 4:55 pm

    It turns out that simple blood pressure medication may halt the progression of chronic diseases like diabetes, hypertension, and emphysema (1). Many diseases may respond to the same basic approach (2).

    This means that retail clinics would be ideal for lessening the burden of chronic disease. No primary care provider can see a patient every few days to get their BP meds right. But a drop-in retail clinic could do so easily.

    I would love to work with any retail clinic and local MDs who want to deliver state-of-the-art care to walk-in patients with chronic diseases!

    I see the retail clinic movement as crucial in moving from hospital-based healthcare to preventive molecular medicine.

    Best regards,

    Dave Moskowitz MD
    CEO
    GenoMed, Inc.

    References
    1: Moskowitz DW. From pharmacogenomics to improved patient outcomes: angiotensin I-converting enzyme as an example. Diabetes Technol Ther. 2002;4(4):519-32.
    PMID: 12396747. (For PDF file, click on paper #1 at: http://www.genomed.com/index.cfm?action=investor&drill=publications)

    2: Moskowitz DW. Is angiotensin I-converting enzyme a “master” disease gene? Diabetes Technol Ther. 2002;4(5):683-711. PMID: 12458570 (For PDF file, click on paper #2 at: http://www.genomed.com/index.cfm?action=investor&drill=publications)



  4. DR on July 19, 2008 at 6:44 am

    As electronic medical records become the norm, it will allow for better continuity of care for those customers who receive medical attention from those who are not their primary care physician. Doctors will have to adjust to a different model of health care – a “team approach”. The patient will have a more proactive role in their health and will rely on multiple health care professionals who will update and communicate with each other via one e-record which the patient will own.



  5. JRS Medical on July 21, 2008 at 12:29 pm

    I only think this can benefit the American public. Wal-mart could pull expert doctors from India to diagnose problems. These qualified doctors get the same trainging as their US couterparts but expecet much less for their services (Average daily wage in India is $1).

    India already provides doctors who read X-rays for American hospitals and accountants who prepare tax returns that get reviewed by this country’s IRS. I expect the quality of care to improve and the coordination of medical information to more easily available and accessible if Google starts allowing medical history information online also.