Pint-Size Clinics Take Root at CVS

By Jim Shamp, The Herald-Sun, Durham, N.C.

Oct. 31–DURHAM — Durham area residents will have some new drop-in health care options starting today, as MinuteClinic health care centers open inside two Durham CVS/pharmacy stores.

The clinics, offering “urgent care lite,” will be staffed by family nurse practitioners providing a range of 15-minute “clothes-on, in-chair” exams and treatments, most for up-front payments of $59. MinuteClinics also accept several forms of health insurance.

The clinics, touted as the first such retail-based health care centers in North Carolina, are opening in rented space at the CVS stores at 6911 Garrett Road and 1845 Martin Luther King Blvd. Another is scheduled to open in the CVS at 3573 Hillsborough Road in December.

Each clinic is in an enclosed room within the host retail store, and each will operate weekdays from 8 a.m. to 8 p.m. and on weekends from 10 a.m. to 4 p.m.

Family nurse practitioners are trained to diagnose, treat and write prescriptions, under a physician’s guidance, for such common family illnesses as strep throat and ear, eye, sinus, bladder and bronchial infections.

MinuteClinic also offers routine vaccinations for influenza; measles, mumps and rubella; tetanus; Hepatitis A and B; and other diseases.

Forty-four MinuteClinic health care centers are operating across the eastern half of the United States, with more being added quickly by the privately owned 3-year-old Minneapolis-based corporation.

The clinics in the Triangle area are owned and operated by Cary nurse practitioner Kristan Broom as MinuteClinic Diagnostic of North Carolina, P.C. Her first clinics are opening in CVS stores in Cary, Raleigh and Knightdale.

A physician who has practiced at several other clinics in the Triangle, DeLora Cummings, is to serve as the local MinuteClinic medical director.

MinuteClinic’s vice president of payer relations, Neil Rolland, said the firm’s local insurance network will include United Healthcare starting Tuesday and Medcost in about two to three weeks, after the insurer approves credentials of the nurse practitioners. Coverage is also expected with Cigna on Dec. 1 and Aetna on Jan. 1, with Humana and Blue Cross negotiations still in process. Some Medicare and Medicaid plans may also be included, he said.

MinuteClinic is one of several companies opening walk-in mini-clinics housed in retail stores, including Target and Kroger. An article in the Sept. 16 issue of Medical Economics magazine listed six other companies getting into the fast-growing, low-overhead business.

The clinics promise fast, no-appointment service for minor health problems. But some area health care providers urge caution in using such facilities.

Several contacted by The Herald-Sun declined to comment on the record. But Chapel Hill physician Glenn Withrow said he hopes people don’t try to use mini-clinic services in place of periodic visits to a doctor.

“I’ve never been in a MinuteClinic,” said Withrow, who founded The Family Doctor family practice and urgent care clinic 20 years ago. “But I have some concerns. Many patients may present with something minor like a runny nose, but the thing that might kill them might be the hidden diabetes or high blood pressure. And this mini-clinic kind of practice doesn’t seem to deal well with that.”

And even if they do discover a blood pressure problem, he said, the nurse practitioner would have to refer the patient back to someone like a primary care physician.

“So the patient may lose time and money in that process,” Withrow said.

Withrow said some people referred to the urgent care segment of The Family Doctor as a “doc in a box” when it first opened.

“Some urgent care clinics do tend to treat one minor problem and not provide continuity of care,” he said.

But he added that he is suspicious any time a provider’s office locates with a retailer or sells its own products.

“How likely is it that a MinuteClinic in a CVS might refer you to another pharmacy, even if it might be to your benefit?” he asked.

Withrow also said the absence of a physical examination at a MinuteClinic could lead patients to a false sense of security.

“I don’t know how they do an assessment if they don’t do an examination of someone’s abdomen on an examining table,” he said. “I have people come in here all the time with what they think are simple problems that turn out to be complex. Last week someone came in with fatigue and thought they had a urinary tract infection because they urinated frequently. It turned out to be diabetes — and an infection. I’d have missed it if not for my lab doing a urinalysis and white blood count.”

Marva Mizell Price, who directs the Duke family nurse practitioner program, said at least one Duke trainee had signed on to work at a MinuteClinic.

She said she saw the concept as “a useful option for busy people seeking help for self-limiting conditions.”

Busy families seeking low-hassle help can call many local doctors’ offices now and get appointments quickly, as more practices include open slots in the schedule for same-day visits. But on weekends, service at urgent care facilities can take several hours.

“These MinuteClinics are not there for chronic diseases and long-term conditions,” said Price, “but rather to answer immediate health conditions. They’re for someone who wants something done right now — especially on a Saturday or Sunday, which is when my kids often seemed to get hurt or sick. If it’s simple, patients can get it taken care of and go back to their activities.”

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