Who’s selling health?

CVS made news a while back for announcing that it would stop selling tobacco products in its stores, and guess what? They’re doing it! The company says they are shifting their focus more to focus on health, including the “MinuteClinics” in many of their stores. So, is CVS a company with a health-based mission? Are they selling us something better than, say, circle K? Or are they just following the crowd? Are they taking a stand for health? Will it help? Or will it just irritate consumers? Are people starting to see CVS and Walgreens as more than a place to buy advil and batteries?

spotted at a local Circle K.

spotted at a local Circle K.

I don’t know. There’s no question that smoking is “out” now, right? Fewer people smoke, everyone knows it kills you, and you can’t do it in bars. That makes the move a little less bold, perhaps, but still: it doesn’t really look like a profit-based decision, at least in the short term. So what about the re-branding as a place to get healthy? Walgreens has their “be well” slogan (are you tired of the cashiers saying that to you? i am. . . .). And now CVS is anti-tobacco.

Which brings us to the clinics: have you been to one? I haven’t, but I did do clinical rotations in one during school. And I’m torn: great to have access to a provider if you have a UTI or strep or need a vaccine and don’t have a regular provider or can’t get an appointment. It’s kind of a boring job for an NP, but hey, it’s a good service, it’s a paycheck, and there’s an argument to be made that it improves patients’ access to care. They’re ubiquitous, open on weekends and evenings, and post (very reasonable) prices for their services. They take insurance. There’s also evidence that patients who use retail clinics have lower healthcare costs and fewer ER visits (This is one study showing the clinics’ positive effects, though its lead author is affiliated with, you guessed it, CVS. This study found that quality of care for basic treatment was comparable with physician’s offices. ).

But. . . I have a few concerns.  First, until electronic health records are more interoperable, we will continue to struggle with documentation. Did you just take an antibiotic three weeks ago? Do you know which one? Do you remember the name of the one you’re allergic to? Do you have a complete list of the other medicines you’re taking right now? When was your last tetanus shot? Chances are, your PCP’s office has this stuff on file, and chances are, you don’t know all the answers. But it matters if you’re in the clinic with an ear infection or a laceration today. Second, some of these clinics are moving beyond treating simple acute conditions and basic preventive screenings and care. They are managing diabetes, high blood pressure, and other chronic issues. Now, don’t get me wrong, NPs can do this and we excel at it. But if you are in a retail clinic, you might see a different provider every time. You might not have a chance to learn to trust someone who wants to monitor you over time. You might not have a good way to get referrals sent to other providers for other parts of your care, and the clinic might not have a good way to receive and organize this kind of information. It’s just not. . . .ideal. Third, the companies who own these clinics want to make money. They’re selling a service, and they are also selling retail goods and drugs. They want you to get care there because it makes them money. That worries me.

Do I have a point? No, not really. I just think it’s interesting to think about it 🙂

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