Retail-based pediatric care? AAP doesn't approve

In a new variant of the "doc in a box" idea, what are called retail-based clinics (RBCs) are popping up in supermarkets, pharmacies, and large retail stores. Usually staffed by a nurse practitioner, these walk-in clinics are being touted as a convenient place to take a child with, say, a sore throat that might be a strep infection or a playground injury that might, or might not, need suturing.

These clinics have advantages: They are often open when the pediatrician's office is closed, they're cheaper than a trip to the emergency department, and a busy parent can combine a visit to the clinic with a shopping trip. Not coincidentally, that same busy parent can fill the child's prescription, if there is one, at the store pharmacy.

But that kind of care is not what the American Academy of Pediatrics calls a "medical home," the gravamen of the AAP's opposition (Editor's note: See the discussion of the medical home in this issue.) Recognizing that RBCs are probably here to stay, however, the AAP is trying to encourage these clinics to refer patients back to their medical home for ongoing care, communicate with the child's primary health-care provider within 24 hours of the visit, follow AAP clinical guidelines, and take precautions to avoid the spread of contagious disease.