Quality of Care in the Retail Health Care Setting Using National Clinical Guidelines for Acute Pharyngitis

Abstract

Rates of adherence to an acute pharyngitis practice guideline in the retail clinic setting were measured as an indicator of clinical quality. An analysis of 57,331 patient visits for the evaluation of acute pharyngitis was conducted. In 39,530 patients with a negative rapid strep test result, nurse practitioner and physician assistant staff adhered to guidelines in 99.05% of cases by withholding unnecessary antibiotics. Of 13,471 patients with a positive rapid strep test result, 99.75% received an appropriate antibiotic prescription. The combined guideline adherence rate for groups with positive and negative rapid strep test results was 99.15%. Strep cultures were performed on 99.1% of patients with a negative rapid strep test result, and 96.2% of patients with a positive culture were treated with an antibiotic. Finally, 0.95% of patients with a negative rapid strep test result were provided an antibiotic outside clinical guidelines; however, approximately half of these prescriptions (n = 190) were supported by documentation of clinical concerns for which an antibiotic was a reasonable choice.

AAP Principles Concerning Retail-Based Clinics

“…[4][5][6] Protocols are followed that dictate conditions and patients who can be seen as well as suggested treatment regimens to be followed. 7 RBC protocols often restrict pediatric ages and conditions that will be seen by the providers. National organizations for member RBCs provide guidelines for accrediting and patient care.…”

“…8 Data on outcomes specifically looking at pediatric patients are limited, but minor illnesses, such as acute pharyngitis, demonstrate no significant issues with early return visits to primary care physicians. 7,12,13 RBCs are located in retail stores, such as grocery stores, drug stores, or "big box" stores. Average driving time for patients is less than 5 minutes, and average income and education for communities with RBCs are above average nationwide.…”

Strategic Response by Providers to Specialty Hospitals, Ambulatory Surgery Centers, and Retail Clinics

“…Comparable results observed in one study of RCs may be due to that study's focus on a site possessing an electronic medical record, uncommon in the offices of primary care physicians. 14 There are potentially important differences nevertheless. While the same providers might see patients in both traditional and disruptive settings and treat them in similar ways, there are fewer consulting colleagues and less technical backup in the disruptive sites, which may limit the overall quality of care that can be provided.…”

A Checkup For Retail Medicine

“…And a one-year study published last year in the American Journal of Medical Quality showed that retail clinic practitioners adhered to clinical guidelines in 99.15 percent of patient visits by not prescribing unneeded antibiotics for patients who'd received a negative rapid strep test. 6 …”