For Patients at Walk-In Health Clinics, Convenience Is the Key

JANUARY 01, 2009
Lauren Green, Associate Editor

Even though I had stopped by our local walk-in clinic to conduct my own interview and get a sense of the operation, I was the one who got the first question: "Have you had your flu shot?"

Family Nurse Practitioner Amy Luster, RN, APN-C, of the MinuteClinic at CVS Pharmacy in Plainsboro, New Jersey, told me that patients seeking flu shots and strep tests are the ones she and her colleagues see most often this time of year. Not surprisingly, patients with conditions like sinusitis, bronchitis, and conjunctivitis also are frequent clinic visitors during the winter months.

In the spring, allergies are a common complaint; the end of summer is a time when teenagers heading off to college visit the clinic for their meningitis vaccinations. "It is a lot faster than doctors' offices," noted Luster. "Once they have tried us, they do come back."

One reason patients are turning to clinics, explained Kathleen Caridi, RN, APN-C, manager of MinuteClinic's operations in central New Jersey, is the convenience. Because walk-in clinics are open 7 days and weeknights for patients without an appointment, they offer an alternative to often crowded physicians' waiting rooms or costly emergency department visits during off-hours.

MinuteClinic health care centers are staffed by board-certified family nurse practitioners and physician assistants who are trained to diagnose, treat, and prescribe medication when it is part of a treatment plan for common family illnesses. Though patients are not required to fill their prescriptions at the pharmacy, they often do, noted Luster—for the convenience.

A Full Menu of Services

The services offered by MinuteClinic cover everything from common illnesses like ear infections, to vaccinations, wellness programs, and camp physicals (Table). Currently, more than 550 MinuteClinics are operating in 27 states. Since its inception in 2000, MinuteClinic reports more than 2 million patient visits.

"We're always looking for more services," noted Caridi. She and Luster pointed out the many prevention and screening programs also offered at the clinics. Through a promotion last May, for example, patients could get free cholesterol, blood pressure, or glucose screenings.

"This starts the discussion," said Luster. "Then we can sit down with the patients, discuss what the readings mean, and also give them informational materials." Smoking cessation counseling is another popular service the clinic offers.

Individuals with illnesses outside MinuteClinic's scope of services, or who exhibit signs of a chronic condition, are referred to their physician or, if critical, to the nearest urgent care center or emergency department.

Complementing a Physician's Care

When patients arrive at the MinuteClinic, they sign in at a touch-screen kiosk, answering the typical questions one might receive at the doctor's office, before being ushered into a private exam room. This sets up a record for future visits, when visitors will only need to enter their name and birth date to sign in. Most patients simply pay the office visit copay indicated on their health insurance card. Treatment prices are posted at the clinics as well, for patients paying by cash or credit. Most treatments at MinuteClinic cost $59.

MinuteClinic staff use a software program that, at the conclusion of each visit, generates educational material, an invoice, and a prescription (when clinically appropriate) for the patient, as well as a diagnostic record that is automatically sent to the patient's primary care provider. If a patient does not have a "medical home," a list of physicians in the area is provided.

"We encourage all of our patients to have a medical home," said Caridi. "We send the record of their visit to their primary care doctors. This is especially helpful for keeping track of children's immunization records."

Every MinuteClinic patient assessment and treatment follows nationally established clinical practice guidelines from the American Academy of Family Physicians, the American Academy of Pediatrics, and the Institute for Clinical Systems Improvement. These guidelines are embedded in the clinic's electronic medical records system. MinuteClinic also has received accreditation from the Joint Commission on Accreditation of Healthcare Organizations.

Outreach, Too

CVS MinuteClinic Servicesa

Common Illnesses
Bladder infections
Ear infections
Pink eye and styes
Sinus infections
Strep throat
Swimmer's ear

Skin Conditions
Athlete's foot
Cold sores
Deer tick bites
Minor burns
Minor skin infections and rashes
Minor sunburn
Poison ivy
Shingles treatment
Wart removal

DTaP, Td, Tdap (diphtheria, tetanus, pertussis)
Flu (seasonal)
Hepatitis A and B
MMR (measles, mumps, rubella)

Wellness & Prevention
Camp physicals
Health screening:
Smoking cessation

Additional Services
Ear wax removal
Flu diagnosis
Pregnancy testing
Suture removal

a Provision of some services is restricted to certain age groups.

Caridi said that one of the most exciting aspects of the clinic model is how it has helped to forge partnerships between clinic staff and pharmacists. "It has helped to join the professions together in a way that helps patients," she said.

She teams up periodically with CVS pharmacists to go out into the community to places like senior centers, to let area residents know about the many services the pharmacy provides, such as free home delivery, as well as the MinuteClinic. They end their talks with a question-and-answer period, when patients often ask about their medications. This outreach, said Caridi, "helps to bring health care back to the community."

Caring Professionals—When You Need Them

While I was on-site, the business was, indeed, mostly flu shots. CVS recently reported that it surpassed its goal of delivering 1 million flu vaccinations during this fall's flu shot season.

Staff at the Plainsboro MinuteClinic explained that new regulations in New Jersey—requiring flu shots for all children aged 18 months to 4 years 9 months who attend day care or preschool— have upped the number of flu shots requested. The regulations took effect January 1, and MinuteClinic circulated flyers on the new state requirement this fall to help keep families informed.

One woman, waiting for her prescription to be filled, came by and asked about preservative-free vaccinations, which the clinic had in stock. She got her flu shot and decided to bring her 4-year-old son, who, like many children' has anxiety about doctor visits, back to the clinic for his flu vaccination the next time they go out shopping.

As I departed, Caridi summed it all up while she was busy answering questions and assisting another patient with the check-in process at the kiosk: "We are here for the convenience."