How to Integrate Clinics

NOVEMBER 01, 2006
Fred M. Eckel, RPh, MS; Pharmacy Times Editor-in-Chief

If an in-store clinic has not appeared near you, it probably will soon. Hundreds of these mini-clinics are already operating in the major chain drugstores and other retailers, and thousands more are scheduled to open in the next few years.

Many chains already seem convinced that these clinics, typically staffed by nurse practitioners and physician's assistants and offering basic medical services, can increase revenue and drive more business through the pharmacy. Some estimates suggest that around 90% of the prescriptions generated at these clinics are filled at the in-store pharmacy.

Yet, will employers continue to value pharmacists as highly if services can be provided by clinics at lower cost? Could increasing reliance on clinics threaten potential growth areas for pharmacy, such as medication therapy management?

A second concern is whether the trend will change the way patients view pharmacists. If patients rely on the clinic's nurse practitioners for diagnosis, will they also rely on the clinic for advice that would previously have been provided by pharmacists? Will they be less likely to go to the pharmacy for advice about OTC drugs, for example?

These concerns are understandable. They do not mean, however, that miniclinics should be seen as a bad thing. On the contrary, the surging growth of these clinics could be a positive development. It is clearly necessary, however, to examine what the pharmacist's role should be and how we can best adapt to the clinic phenomenon.

We can start by developing a good working relationship with the clinic, encouraging the clinic's staff to refer patients with drug therapy management questions to us, for instance.

On a larger scale, we need guidelines for the relationship between the pharmacy and the clinic. Today, the American Medical Association (AMA) has a set of principles for store-based health clinics, covering such areas as clinics' responsibility to refer patients to physicians when the patients' needs are beyond the scope of the clinic's services.

In a similar way, each store with a clinic should establish principles and protocols that define when clinics should refer patients to pharmacists. Perhaps pharmacy associations might develop guidelines for this.

Handled the right way—so that pharmacists and clinic staff offer complementary services and clearly understand their respective roles—the result could benefit everyone.

Mr. Eckel is professor and director of the Office of Practice Development and Education at the School of Pharmacy, University of North Carolina at Chapel Hill.


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