Credit: Rose Hoban

More and more, patients are getting their healthcare outside the doctor’s office. And the trend is bound to grow.

By Brenda Porter-Rockwell

On a recent afternoon, Norma Summers and one of her friends decided it was time to get their flu shots. But neither woman went to the doctor, instead they walked into a tent at the N. C. State Fair and rolled up their sleeves.

Norma Summers gets her flu shot at the N.C. State Fair last week. Summers said
Norma Summers gets her flu shot at the N.C. State Fair last week. Summers said she likes to get her flu shots at the drug store because it’s quicker. Photo: Rose Hoban Credit: Rose Hoban
Norma Summers gets her flu shot at the N.C. State Fair last week. Summers said she likes to get her flu shots at the drug store because it’s quicker. Photo: Rose Hoban Credit: Rose Hoban

Several pharmacists from Kerr Drug talked Summers through a consent form and basic questions about her medical history and insurance. Then Summers signed a form and got her shot.

“I like to get my flu shot at the drug store because they have it quicker,” said Summers, who lives in Blanch, N. C. “Last year, I got it at Walmart. I kept asking the doctor and she kept saying, ‘We ain’t got it yet.’”

Similar transactions like this take place hundreds of times per day in North Carolina supermarkets, big-box stores, and drug stores. In fact, it was 1998 when North Carolina-based Kerr Drug launched the first retail treatment clinic in the country, where patients could get basic clinical services in the convenience of their local drug store.

Now, there are more than 1,100 such clinics across the country as more and more consumers have skipped the traditional medical campus in favor of alternative locales to manage healthcare needs with mobile HIV clinics in parking lots, and flu and other vaccines delivered at the pharmacy.

“The routine stuff like tests for health monitoring didn’t require a doctor’s visit. You don’t have to schedule a doctor’s visit to get a flu shot or get screened for HIV anymore. It’s amazing to see what has become ‘routine,’ ” said Winny Tan, an industry analyst with Frost & Sullivan Research in Mountain View, CA.

Skipping the doctor’s office

Convenience is at the top of the list for patients who visit non-traditional settings, Tan said. High unemployment rates have also played a role in keeping people away from doctors, as workers lost their employer-supported insurance in the economic downturn.

In the past, Tan said, access, for example, to quality healthcare used to be largely determined by whether a person had health insurance or not. A person with a health insurance plan was more likely to see the doctor and use health services. However, as she pointed out, not all health concerns actually require a visit to the doctor.

Workers from this Kerr Drug tent at the N.C. State Fair estimated they would give several thousand flu shots during the 11 day event.
Workers from this Kerr Drug tent at the N.C. State Fair estimated they would give several thousand flu shots during the 11 day event. Photo: Rose Hoban Credit: Rose Hoban

That was the insight that Kerr Drug had 15 years ago when it rolled out the Enhanced Pharmaceutical Care Center model – resource centers within several of its pharmacies that  became the foundation for the integrated care the chain provides today.

Today visitors can walk into any of the 76 Kerr Drug locations and receive various clinical services such as medication therapy management, vaccinations, and other programs to promote adherence and proper medication use.
And the company sets up a tent at the State Fair every year to give flu shots, next door is a tent selling everything from band-aids to batteries.

We’ve been doing this for ten years,” said Stan Edmundson from the Kerr Drug in Sanford. He said last year, they gave more than 2,000 shots at the State Fair.

“Some people say they get it every year at the Fair,” he said. “We got music and turkey legs and flu shots.”

Other pharmacy chains soon followed Kerr Drug’s lead in delivering care in non-traditional settings. In 2006, Rhode Island-based CVS  acquired the MinuteClinic, a collection of retail healthcare centers. Twelve months later, Pennsylvania-based Walgreens  purchased Take Care clinics. By 2008, WalMart had formed partnerships with Houston-based RediClinic and St. Vincent Health Systems in Little Rock.

“Pharmacists have been found to be more accessible than traditional healthcare providers,” said Abby Reynolds, PharmD, Kerr’s Manager of Clinical Programs. In North Carolina and many other states, pharmacists can provide routine care like annual flu shots.

“This is an integral part of the customer’s visit into our stores. This is not to take away or replace care from their other healthcare providers; we see ourselves as a component of the healthcare team,” explained Reynolds.

Location, location, location

Because the patients are in the pharmacy once or sometimes two or three times per week, Reynolds said the frequency makes providing health management easy.

“It’s in-and-out rather than going to their doctor’s office and having to wait in the waiting area and possibly interact with other sick patients. They can come into the pharmacy, which is easily accessible, and prevent [sickness] from happening,” said Reynolds.

Affordability of the retail clinic is also a plus. A study by the healthcare organization, HealthPartners, found that cost for care given in a retail clinic was 32 to 35 percent less than care delivered in physician offices and urgent care.

“It’s no wonder the large retail companies have jumped in. There’s clearly an opportunity to enhance the customer service side of delivering health,” said Tan.

In 2010, Forsyth County Department of Public Health jumped into the fray of providing alternative access to healthcare management. The department’s POSSE (Preventing the Spread of STD’s Everywhere) team introduced a new custom-built mobile unit to test for sexually transmitted diseases (STD’s) and HIV away from Health Department offices.

The community-based vehicle was paid for by a grant from the N.C. Department of Health and Human Services and is used to conduct off-site syphilis testing and rapid HIV testing where results are viewed in 10-15 minutes.

The unit contains a private counseling area, a space for blood draws, an on-board refrigerator for storing blood samples, and an external television where those in line can watch educational videos while they wait to be seen. With the aid of the vehicle, workers are now able to target nightclubs and other venues that were unattainable as testing locations in the past.

Trend will only spread

Another driver of this expanding access to health care trend is a greater importance placed on preventive measures to maintain health in both federal and state laws and in technological advances.

“This shift is accelerated by technology and interconnectiveness. It’s easy for people to stay informed though internet resources and even mobile applications. With people caring more about maintaining health, they are going to use these routes more often,” said Tan.

Tan said the shift to more convenient healthcare access points will certainly continue. Another important industry trend likely to draw consumers away from the doctor’s office is the continued simplification of diagnostic testing.

“There is an entire industry consisting of point-of-care-tests (POCT), which are essentially simple tests that don’t have be to performed in a clinical lab,” said Tan pointing to at-home pregnancy tests and, now at-home HIV tests.

“The growing POCT industry and trend of complex diagnostic testing towards POCT will only help expand the breadth of health services that can be accessed without a traditional doctor’s visit,” said Tan.

Rose Hoban contributed reporting to this article.

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Brenda Porter-Rockwell's experience spans more than a decade of writing, reporting and managing publications (for- and non-profit businesses and public relations agencies) on topics ranging from local...