Trends in retail clinic use among the commercially insured

Abstract

Objectives: To describe trends in retail clinic use among commercially insured patients and to identify which patient characteristics predict retail clinic use.

Study design: Retrospective cohort analysis of commercial insurance claims sampled from a population of 13.3 million patients in 22 markets in 2007 to 2009.

Methods: We identified 11 simple acute conditions that can be managed at a retail clinic and described trends in retail clinic utilization for these conditions. We used multiple logistic regressions to identify predictors of retail clinic versus another care site for these conditions and assessed whether those predictors changed over time.

Results: Retail clinic use increased 10-fold from 2007 to 2009. By 2009, 6.9% of all visits for the 11 conditions were to a retail clinic. Proximity to a retail clinic was the strongest predictor of use. Patients living within 1 mile of a retail clinic were 7.5% more likely to use one than those living 10 to 20 miles away (P <.001). Women (+0.9%, P <.001), young adults (+1.6%, P <.001), patients without a chronic condition (+0.9%, P <.001), and patients with high incomes (+2.6%, P <.001) were more likely to use retail clinics. All these associations became stronger over time. There was no association between primary care physician availability and retail clinic use.

Conclusions: If these trends continue, health plans will see a dramatic increase in retail clinic utilization. While use is increasing on average, it is particularly increasing among young, healthy, and higher income patients living close to retail clinics.

Figure. Monthly Rate of Retail clinic Use 2007 to 2009 Among Subsets of the Enrollee Population^a

^aFigure presents unadjusted monthly utilization of retail clinics for acute conditions among the population of all enrollees who had a visit for a retail clinic-sensitive condition leg. sinusitis, pharyngitis) at any point in 2007 to 2009. A full list of conditions is provided in the text (Methods. Focus on Acute Care Visits). Panel 1 focuses on all enrollees. Panels 2 to 6 divide the population into different groups. Panel 2 divides the enrollees based on the distance from their residence to the nearest retail clinic. Panel 3 divides the nonelderly population by age. Patients aged <2 and >65 years were excluded from the study. Panel 4 divides the population by the presence of chronic illnesses. A description of measures is provided in the Methods. Predictors of Retail Clinic Use section of this article. Panel 5 divides the population by sex. Panel 6 divides the population by income (low: >2 times the federal poverty level; middle: >2 times the federal poverty level to $59,000: high: ≥$59,000).