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2 combs, toothpaste and a clinic visit

Corner stores may alter care as we know it.

By LISA GREENE, Times Staff Writer
Published December 1, 2007

Nurse practitioner Felicia Dennis, left, gives walk-in patient Christina Perez, 23, a flu shot at the CVS clinic on 9th St. North in St. Petersburg.
	[James Borchuck | Times]

ST. PETERSBURG - Carolyn Bernando's head ached and her throat hurt so much that she knew she needed help, but she didn't have a regular doctor and didn't know where to go.

That's how she wound up in a new kind of health clinic last week: the one at the drugstore.

She arrived at the MinuteClinic at the CVS in St. Petersburg's Gateway area about lunchtime and left 15 minutes later with a prescription for an antibiotic to treat her sinus infection, a list of doctors she could try and a recommendation to stop smoking and watch her blood pressure.

The clinic is one of nearly a dozen that have opened at drugstores and other retailers across the Tampa Bay area in the past few months. CVS has opened seven clinics in Hillsborough, Pinellas and Pasco counties since September; Walgreens opened four locally two weeks ago. Both chains have plans to open more, joining Publix and Wal-Mart, which had clinics already.

As such clinics sprout across the nation, they could change how Americans take care of their routine health problems.

"It sort of compares to how ATMs came about for banking," said Sherry Roberts, a nurse practitioner who manages Tampa Bay's seven CVS MinuteClinics. "It really is a new concept in how people get health care."

The clinics have much to offer: They promise lower cost and more convenience than a typical trip to the doctor's office. They're open evenings and weekends, no appointments needed. A typical visit takes 15 minutes.

They advertise their prices: Bronchitis, $49. Camp physical, $25. Flu diagnosis, $83.

They are typically staffed by nurse practitioners, registered nurses with advanced training. They can prescribe all drugs except controlled substances.

But some health experts are troubled by a world in which health care is bought and sold right next to shampoo, deodorant and candy bars.

Critics worry that clinic practitioners might miss signs of an emergency. Their patients might become even less likely to have a regular doctor, a place to get preventive care and attention for chronic problems, they say.

"They're not established to help people take care of their diabetes or their blood pressure," said Dr. Jim King, president of the American Academy of Family Physicians. "They're not set up for preventive care. ... There are multiple companies popping up, so you really don't know what you're getting."

But the clinics aren't meant to replace family doctors, said Peter Miller, president and CEO of Take Care Health Clinics, owned by Walgreens. The clinics follow guidelines and treat only minor illnesses, such as ear infections, strep throat and pinkeye.

"We view ourselves as a beginning, not an end," Miller said. "We counsel everybody ...on the need for a primary care provider."

Such clinics are popular because the nation's health system has problems, King admitted. With a shortage of primary care doctors, going to the doctor has become an ordeal. Sick patients beg to get appointments three days away and chafe in waiting rooms to snag a few moments with a hurried doctor.

"The academy feels the clinics are a symptom of an ill health care system," King said. "Patients have problems getting in to see doctors. This industry has popped up to fill that need."

Convenient care

Need is what drove Bernando to the St. Petersburg CVS. She wasn't sure where to go; a co-worker told her about the clinic.

Bernando went to the back of the store, where MinuteClinic shares a few chairs as a waiting area with the pharmacy. Nurse practitioner Felicia Dennis saw her right away in a private exam room. It has a sink, counter and a desk with a computer. There are chairs, but no exam table.

With Bernando's blood pressure and temperature checked, she and Dennis talked about her sore throat and the pain in her face and lymph nodes. Dennis peered in her ears, throat and nose and listened to her breathe.

"You've got some sinus issues going on," Dennis told her.

Dennis asked an electronic list of questions, prescribed an antibiotic and recommended some cold medicines. She told Bernando her smoking might make her more susceptible to infection and explained why she needed to finish her antibiotic, even if she felt better. She told Bernando that her blood pressure needed to be watched and gave her a list of primary care doctors.

It's a lean operation; Dennis herself checked in patients and took their cash as well as their temperatures.

Bernando left ready to use the clinic again in the future.

"I was kind of iffy about it," she said. "But once I got in there, you could tell she knew what she was doing."

Bernando and two other lunch-hour patients said they felt comfortable seeing a nurse practitioner instead of a doctor.

"I like nurse practitioners better, quite frankly," said Linda Maloney of Massachusetts, who got a flu shot. "They take their time and explain things."

At a Brandon Walgreens, Riverview resident Ryan McGrath, 29, said he didn't mind not seeing a doctor.

"Half the time when you go to a clinic, you see a nurse practitioner anyway," he said.

McGrath said he wouldn't go to the clinic for a serious problem, but for his sinus infection, it was quicker and easier.

Setting limits

That's what retail clinics are for, said Michael Howe, CEO of MinuteClinic, a CVS subsidiary.

"We've got a health system that does a wonderful job of diagnosing and treating complex conditions and cases," he said. "But what this has done is put a light back on something that touches far more lives, and is a source of frustration for a lot of people."

Health experts hope the clinics won't just be convenient but also quick and affordable enough for people without insurance.

"A lot of uninsured people tend to wait until they can go to emergency rooms," said Dr. Stephen Schoenbaum, executive vice president for programs of the Commonwealth Fund, a health policy research group. "These services tend to be a lot less expensive."

The Walgreens and CVS locations are in prosperous, suburban areas, not in poorer neighborhoods where the uninsured are more likely to visit. But Howe and Miller said their clinics will open in such places, and they want to make care more affordable.

Critics worry that clinic practitioners might fail to diagnose serious illnesses. Others - including a doctor whose walk-in clinics might lose patients to the retail operations - say that's unlikely.

"Twenty-seven years ago, when we opened our first clinic, we received the same criticism," said Dr. Stephen Dickey, medical director of Doctor's Walk-In Clinic, which has seven locations in the bay area. "That didn't materialize. When people have chest pain, they won't go to a grocery store. They'll go to the ER."

In the meantime, the clinics may do more than attract patients. As more clinics spread, they're pushing doctors to change practices by offering more same-day appointments, evening hours and similar services, King said.

King should know. In his practice in Tennessee, he and his partners have set up a new service.

They call it the fast-track room.

Times staff writer Andrew Meacham contributed to this report. Lisa Greene can be reached at greene@sptimes.com or (813) 226-3322.

Convenience clinics

New health clinics at neighborhood retailers market themselves as convenient and quick alternatives for minor illnesses.

MinuteClinics

Inside CVS/pharmacy, seven in the bay area.

Hours: 8 a.m. to 8 p.m. Mon.-Fri.; 10 a.m. to 4 p.m. Sat.-Sun.

For locations: www.minuteclinic.com/en/USA/.

Take Care Health Clinics

Inside Walgreens, four in the bay area.

Hours: 8 am to 7:30 p.m. Mon.-Fri.; 9:30 a.m. to 5 p.m. Sat.-Sun.

For locations: www.takecarehealth.com.

CheckUps

Inside Wal-Mart, one location in New Tampa.

Hours: 8 a.m. to 8 p.m. Mon.-Sat.; 10 a.m. to 6 p.m. Sun.

For location: www.checkupsusa.com.

The Little Clinic

Inside Publix stores, six locations in the bay area.

Hours: Varies, but largely 8:30 a.m. to 8:30 p.m. Mon-Fri; 8:30 a.m. to 6:30 p.m. Sat.; 11 a.m. to 5 p.m. Sun.

For locations: www.thelittleclinic.com.

[Last modified November 30, 2007, 22:09:41]