AAP Principles Concerning Retail-Based Clinics

Has anyone read the recent policy statement issued by the American Academy of Pediatrics regarding retail-based clinics that was issued in December? You can find the complete paper at www.pediatrics.org/cgi/doi/10.1542/peds.2006-2681 .

From the AAP’s policy statement: "The American Academy of Pediatrics (AAP) opposes retail-based clinics (RBCs) as an appropriate source of medical care for infants, children, and adolescents and strongly discourages their use, because the AAP is committed to the medical home model." Some of the concerns outlined include "the fragmentation of care, possible effects on quality of care and the use of tests for the purposes of diagnosis without proper follow-up."

The AAP’s Retail-based Policy Work Group recognizes that RBCs will continue to exist and expand and lists the following principles that should guide their growth: 1) RBCs should support the medical home model by referring the patient back to the pediatrician or other primary care physician for all future care, 2) Communication with the patient’s pediatrician or PCP should occur within 24 hours of the visit, 3) The use of evidence-based medicine, 4) RBCs should be subject to and comply with all health care facility standards, and 5) The AAP is opposed to waiving or lowering copays or offering financial incentives for visits to RBCs in lieu of visits to pediatricians’ or other primary care physicians’ offices.

Well, here's my response:

Dear Membership of the AAP:

Nurse Practitioners and Physician Assistants working in RBCs have as much of a professional interest in providing patients with quality care as pediatricians. We understand the need for continuity of care. We provide referrals to physicians when a patient does not have a "medical home". We have supervising physicians who collaborate closely with us on the development of our guidelines. We comply with health care facility standards. We communicate with our patients’ physicians when they are seen in our offices. We refer patients to physicians when their health warrants a referral and when their presenting condition exceeds our scope of practice as defined by our company – which is, by the way, much more restrictive than when we, as NP’s or PA’s, worked for you in your offices.

Reatil-based clinics are a new phenomenon. There is not enough research to substantiate many of the claims made in the AAP's policy paper. Furthermore, to say that providers in retail-based clinics perform diagnostic tests without proper follow-up is an insult to our professional standards. To say that we, as professional healthcare providers, contribute to the fragmentation of healthcare without acknowledging the essential role we play in providing access to care for thousands of uninsured children is irresponsible. And finally, to suggest that our presence in a retail setting provides more of a public health risk than a pediatrician’s office is absurd.

We strongly encourage the AAP to research and revise its recommendations on the use of retail-based clinics for children and adolescents. As this model of healthcare evolves there will be increasing opportunity for collaboration between the NPs and PAs that staff these clinics and community-based physicians. We want to work with you, as colleagues and continue to make a positive contribution to the healthcare needs of children in this country.