Not in my backyard- healthcare

[BT]

Menino decries clinics in retailers
Urges health council to bar infirmaries from opening in city

By Stephen Smith, Globe Staff  |  January 11, 2008

Mayor Thomas M. Menino embarked on a highly public campaign yesterday to block CVS Corp. and other retailers from opening medical clinics inside their stores, an effort that exposed a rift between Menino and the state's public health commissioner, a longtime ally.

Menino blasted state regulators for paving the way Wednesday for the in-store clinics, which are designed to provide treatment for sore throats, poison ivy, and other minor illnesses.

The decision by the state Public Health Council, "jeopardizes patient safety," Menino said in a written statement. "Limited service medical clinics run by merchants in for-profit corporations will seriously compromise quality of care and hygiene. Allowing retailers to make money off of sick people is wrong."

In a separate letter, Menino urged members of the city's Public Health Commission to consider barring the clinics from Boston. CVS executives said they plan to open 25 to 30 MinuteClinics in Greater Boston before the end of the year, although they have not specified how many of those will be within the city's limits.

The Boston Public Health Commission spent nearly an hour discussing the impending arrival of the clinics and ways they could potentially be stopped.

The panel took no action, but instructed the health agency's attorney to investigate whether it could adopt regulations forbidding stores with clinics from selling tobacco products, forcing them to make an untenable financial choice. The city says 31 CVS stores and 56 other pharmacies in Boston have city-issued licenses to sell tobacco.

In a statement issued last night, executives of MinuteClinics said they "would be happy to talk to Mayor Menino about any of his concerns."

"We at MinuteClinic are committed to providing convenient, affordable access to quality health care," the statement said.

By issuing a broadside against the clinics and the state's approval of them, Menino placed himself squarely in opposition to a former longtime deputy, John Auerbach. Before becoming the state's public health commissioner last year, Auerbach spent nine years as executive director of the Boston Public Health Commission.

Auerbach's state agency yesterday released a statement defending its decision on the clincs: "The members of the Public Health Council were deliberative and thoughtful in their review of the limited service clinic regulation. We believe these types of clinics, operated either as part of a retail operation or in a nonprofit setting, can provide the public access to safe, convenient, and quality care for minor health issues."

The clinics are not designed to treat chronic diseases such as cancer or diabetes or serious emergencies. The facilities will be staffed with nurse-practitioners who are trained to spot patients with more severe illnesses or in need of specialized care and send them to a doctor or an emergency room.

The regulations apply to any retail company, hospital, or community health center that wants to open a limited-service clinic outside traditional settings.

Members of the Public Health Commission acknowledged many of the mayor's concerns yesterday, but they also said a solution needs to be found for patients who can't get easy access to primary-care doctors or who spend hours waiting to have routine illnesses treated in emergency rooms.

Commission member Hortensia Amaro, a Northeastern University professor, said her own experience trying to make an appointment illustrates the crisis.

"It's almost impossible to get a primary-care doctor in Boston," she said. "I've waited nine months to get an appointment, and I have great insurance."

Still, members of the commission said clinics inside retail stores might only exacerbate long-standing problems in the healthcare system. Dr. Paula Johnson, a board member and physician at Brigham and Women's Hospital, said episodic visits to a drug store clinic could defeat efforts to provide patients with a reliable continuum of care.

"We could be setting ourselves up for some real problems," she said.

Stephen Smith can be reached at stsmith@globe.com.

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[Plane]

Nurse Practicioners sound like a good idea to me.

But I can't tellif this idea would work without seeing it tried.

Is Mayor Thomas M. Menino a clairvoiant?

Does he know this would work or fail already?

If this idea works poorly it will be unpopular and unprofitable.

If it works well it could shorten the wait in doctors offices by cearing the minor ailments that don't require a doctor to reat from the waiting rooms.

Why isn't it worth a try?

[BT]

Why isn't it worth a try?

That's the billion dollar question, isn't it?

[Lanya]

The times I've been examined by nurse practitioners, I've found the exams to be more thorough than a doctor's exam, the questions to be more lengthy and probing, and the willingness to answer a few questions was there.  It was really something.
Not that this always happens in an urgent care clinic, but the nurse practicioners at our hospital's urgent care place do a very good job. 

[hnumpah]

The times I've been examined by nurse practitioners, I've found the exams to be more thorough than a doctor's exam, the questions to be more lengthy and probing, and the willingness to answer a few questions was there.  It was really something.
Not that this always happens in an urgent care clinic, but the nurse practicioners at our hospital's urgent care place do a very good job.

Nurse practitioners' work is usually reviewed by physicians, whose licenses may also be on the line of the nurse practitioners in their office make critical mistakes. This is one reason they are usually more thorough - they want to be sure they don't leave anything out when they pass their paperwork on up the chain. A physician might not depend on questions as much as he does on direct personal observation of the patient he is examining, observations that might be wrong more often than if they simply asked direct questions (and got honest, complete answers). NP's may also not be as pressed for time as physicians, and patients might be more willing to open up to them, where they might be more intimidated by a doctor.

[The_Professor]

So then, do we not all agree with Plane: "Why not try it?"

[BT]

So then, do we not all agree with Plane: "Why not try it?"

Absolutely. The consumer should have the choice.

Govt should not stand in the way of this.

[Plane]

We need the other side of this question to be expounded.

Does anyone here agree with the Mayor or have some insight to his reasoning?

[Lanya]

One thing I have heard that may be a factor, I don't know...
Some urgent care places dispense meds.  No need to go anywhere else, the meds are included with the list of aftercare instructions. 
I can see that as a reason to be somewhat wary of a clinic in a CVS or a Wal-Mart.
Not enough to deny them, though.