Journal of Nursing

The Physician Assistant is In-Just Not In A Doctor


SAUSALITO, CA (ASRN.ORG) -- One morning last month, when 12-year-old Ashley Sayadian woke with a nasty earache, her mother decided against waiting for an appointment at their busy pediatrician's office. Instead, they visited a local drugstore clinic.

"I called a nurse friend first, and she said it sounded very classic swimmer's ear. We were outside the walk-in hours at the pediatrician, so we came here," says Shirl Sayadian, 43, of Oakton, Va.

Minute Clinic, where Ashley and her mom visited, is the largest retail clinic chain in the country, with 600 locations in CVS stores. Nurse practitioners and physician assistants typically staff the locations.

"I was in massive pain. They helped me by giving me an Advil and cups of water," says Ashley, a swimmer and soccer player, smiling as her mom pops over to the pharmacy to pick up her prescription, antibiotic drops for an outer-ear infection.

Almost half of Minute Clinic patients don't have a primary-care doctor, says physician and Minute Clinic president Andrew Sussman. He is the associate chief medical officer for CVS Caremark, which added 45 clinics this year.

Some without health insurance say they find the clinics a faster, less pricey alternative to urgent care or emergency room visits. But insured patients are increasingly turning to the convenience of drugstore clinics and other medical resources outside the traditional doctor's office when they can't schedule day-of appointments with their primary-care provider.

The clinics address acute but not typically life-threatening conditions such as strep throat, flu symptoms and bladder infections. Many offer vaccinations, and sports and camp physicals.

About 60% of clinic patients are children with conditions such as poison ivy, bronchitis, chickenpox and earaches, says family nurse practitioner Anne Pohnert, who staffs the Vienna clinic three days a week and manages operations for the 16 CVS Caremark Minute Clinics in Northern Virginia.

There are about 1,250 retail-based convenient-care clinics in the USA; in 2006, there were only 175, says Tine Hansen-Turton, executive director of the Convenient Care Association in Philadelphia. Two-thirds are in drugstores and one-third in retail settings, such as Wal-Mart and Target and supermarket chains, she says.

Health insurers are getting in on the game, too. Cigna Medical Group has 11 CareToday clinics in strip malls in Phoenix, says spokeswoman Leigh Woodward. A visit for an earache runs $59, not including medication costs.

There are advantages and disadvantages to the clinics, says internist David Winter, chairman of HealthTexas and Baylor Healthcare System, who has a private practice in Dallas. "They're great for quick diagnoses of acute illnesses like earaches and sprained ankles, or for immunizations, but they're not good for the management of chronic conditions such as diabetes and heart failure," he says. He says complicated diagnoses, such as vague chest pains, are best treated by a physician or at a hospital emergency room.

Minute Clinics aren't outfitted to treat concussions, broken bones and heart attacks, Pohnert says; the nurse practitioner calls 911 when patients require advanced emergency care. They also don't treat babies under 18 months, she says.

Winter says some clinics are good about giving patients a copy of their medical record, or faxing or electronically sending a report to their doctor. "This tells me we can embrace them and work with them," he says.

The nearby pharmacist is one perk, Shirl Sayadian says: "We're 30 feet from diagnosis to pharmacy. I'm very busy, and this is one-stop shopping -- very convenient."

2006 175

Today 1,250

Source: Convenient Care Association

When to consider a retail clinic:

•For quick diagnosis of acute conditions like earaches, sprains, flu.

•Immunizations, sports or camp physicals.

See a doctor…

For treatment of chronic conditions, such as diabetes and heart failure, or symptoms like vague chest pains, says Dallas internist David Winter. Minute Clinics don't treat concussions, broken bones, heart attacks or babies under 18 months.


Copyright 2011- American Society of Registered Nurses (ASRN.ORG)-All Rights Reserved 


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Editor-in Chief:
Kirsten Nicole

Editorial Staff:
Kirsten Nicole
Stan Kenyon
Robyn Bowman
Kimberly McNabb
Lisa Gordon
Stephanie Robinson

Kirsten Nicole
Stan Kenyon
Liz Di Bernardo
Cris Lobato
Elisa Howard
Susan Cramer