Use of Retail Medical Clinics Rises 10-Fold Over 2-Year Period

The number of individuals who used retail clinics located in pharmacies and other settings increased 10-fold between 2007 and 2009, according to research published in the November issue of The American Journal of Managed Care. Age, health status, income, and proximity to the clinic were identified as key factors in choosing a retail clinic over a physician’s office.

In the study, researchers from the RAND Corporation studied usage trends among 13.3 million adults with health insurance; of those, 3.8 million individuals visited a clinic at least once between 2007 and 2009. During the study period, the rate of utilization increased from a monthly tally of 0.6 visits per 1000 enrollees in January 2007 to 6.5 visits per 1000 enrollees in December 2009.

Lead author J. Scott Ashwood, MA, and colleagues found that proximity to the retail clinic was the strongest predictor of use. Other findings are as follows:

• Women were more likely to visit clinics than men

• Retail clinic patients tended to be between the ages of 18 and 44 years

• Those from zip codes with median incomes of more than $59,000 were more likely to use retail clinics than lower income groups

• Individuals with a chronic health complaint were less likely to use retail clinics

The researchers noted that care initiated at retail clinics is 30% to 40% less expensive than similar care provided at a physician’s office, and 80% less expensive than similar services provided in an emergency department.

“If the growth in retail clinic visits that we noted represents substitution for other sources of care, then the increase in retail clinic use could lead to lower costs,” Ashwood said. PT

Women’s Use of Mental Health Meds Rising Sharply

A new report from Medco Health Solutions found that more than 1 in 5 adults in the United States took at least 1 medication commonly used to treat a psychiatric or behavioral disorder in 2010. Among women, the prevalence increased to 1 in 4, according to analysis of mental health medication usage among approximately 2.5 million insured Americans.

The report, which compared utilization of antidepressants, antipsychotics, attention- deficit/hyperactivity disorder (ADHD) drugs, and anti-anxiety treatments from 2001 to 2010, showed that women of all ages take more mental health medications than men.

Antidepressants are by far the most commonly utilized drug, with more than 20% of women taking a medication typically prescribed to treat depression. Anxiety treatments are also widely used by women and at almost twice the rate of men, with use highest among middleaged women (11%).

Although boys are prescribed treatments for ADHD more often than girls, the trends seem to reverse by adulthood. Overall, the number of women taking ADHD drugs was 2.5 times higher than in 2001, surpassing men. The most drastic increase was seen in women aged 20 to 44 years, whose numbers rose 264% in 10 years.

The report also found a significant spike in utilization of atypical antipsychotics among men, with the rates quadrupling among those aged 20 to 64 years since 2001.

The overall results are “sobering and important,” said Martha Sajatovic, MD, of University Hospitals Case Medical Center. “The health care implications could be substantial given increasing financial constraints on individuals and health care funding entities.”

Seniors in Home Care at Increased Risk for Unsafe Medications

Nearly 40% of older adults receiving care from a home health agency are taking at least 1 prescription medication that is considered potentially inappropriate for seniors.

In a study published in the November issue of the Journal of General Internal Medicine, a team of researchers led by Yuhua Bao, PhD, of Weill Cornell Medical College, found that home health care patients 65 years and older are prescribed potentially inappropriate medications (PIMs) at rates 3 times higher than patients who visit a medical office. Home care patients, according to the research, take 11 medications on average.

“Elderly patients receiving home health care are usually prescribed medications by a variety of physicians, and it’s a great challenge for home health care nurses to deal with prescriptions from many sources,” said Dr. Bao. Having a medical professional visit the patient, she added, provides “an opportunity to do a proper medication review and reconciliation.”

A review of data from 3124 home health patients 65 years and older revealed that 38% were taking at least 1 PIM, and that patients taking 15 or more medications were 5 to 6 times as likely to be prescribed PIMs as those taking 7 or fewer medications. Of those individuals taking at least 1 PIM, 21% were taking 15 or more medications.

Many physicians aren’t aware of which medications fall under the PIM category, according to Dr. Bao. “In our fragmented health care system, we generally don’t have an electronic reference for a patient that lists all medications from different physicians, and there isn’t a readily available means for professionals to share essential information. Enhanced physician communication with home health care nurses may help to address the problem, as well as better communication among physicians.”