In the past decade, millions of Americans each year have skipped the doctor’s office or emergency room and headed to a pharmacy for everything from a flu shot to treatment for strep throat.
The nation’s largest drugstore chain, Walgreens, recently announced that staff at its 360 clinics can now assess, treat and manage more chronic illnesses such as asthma and diabetes.
Meanwhile CVS boasts 640 Minute Clinics in the U.S. with plans to have 1,500 by 2017.
All these clinics are staffed by either nurse practitioners or physicians’ assistants. Both can write prescriptions and have advanced degrees.
The clinics are clearly meeting a public demand — one that is forecast to grow as the population ages and the Affordable Care Act extends insurance to another 34 million people. A survey published in January indicates that more than one-quarter of Americans have been to one of these clinics in the past two years. They cite convenience _ no appointments, short waits and extended hours — as reasons.
And three-quarters of them had health insurance.
Some physicians fear this expansion could poses a health threat to the people treated.
Instead of having a “medical home” where a physician knows the patient’s history, more patients will be leaving pieces of their medical histories scattered about town in various pharmacies.
“What about your mammograms, what about your diet or mental health? They’re going to take care of parts. They aren’t going to provide comprehensive medical care,” said Dr. Jeffrey Cain, president of the American Academy of Family Physicians, who practices in Denver.
Cain and the academy do not write off pharmacy clinics entirely.
“If they’re doing it in collaboration with a primary care physician, sharing lab results and information … that could enhance their care. But how do you make sure that happens?” asked Cain.
But when pharmacy clinics take on the treatment of more chronic conditions such as hypertension or diabetes, Fortier worries that they are taking on too much.
“The goal of the clinics from the very beginning was to work in collaboration with the medical community,” said Sandra Ryan, chief nurse practitioner for the Walgreens clinics.
But a pile of studies and statistics indicate that not everyone has a regular doctor — by Walgreens’ survey of its clients, about 30 percent to 40 percent don’t.
“What we see every day is people will come in for an acute illness,” Ryan said. “But they’ll also have undiagnosed high blood pressure. The question is: What do you do then?”
Until now, the clinic’s staff alerted the patient to his or her diagnosis, but all they could do was urge the patient to seek a physician’s care. Under Walgreens’ new policy, the staff could go further by beginning treatment.
But even after the patient has begun treatment, Walgreens will continue to refer him to a doctor.
At every turn, Walgreens and CVS say their practitioners refer patients back to their primary care doctors when they have one. If the patient doesn’t have one, the pharmacies keep a list of local physicians who will take patients.