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Monitor Board of Contributors: Overdosing on urgent care

There has recently been an influx into the Concord area of walk-in clinics. In fact, there are now four in this city of 42,000, where only one had sufficed in the past. The longest standing is the Horseshoe Pond Urgent Care center, which is affiliated with Concord Hospital and has direct communication and interaction with the Concord Hospital ER as well as being staffed by local physicians who own their emergency medical practice. A few years ago Concentra came into town, and this year we suddenly have Convenient MD (conveniently located next to Buffalo Wild Wings!) and CVS Minute Clinic.

This is a lot of urgent care for a small city that has many physicians who pride themselves on providing true “medical homes” for their patients. Most of our offices have extended hours, and all physicians’ offices in the Concord area have 24-hour phone triage coverage. In fact, our contracts with insurance companies require us to provide 24-hour coverage for our patients. But, more important, we want to be there for our patients.

In fact a study from the first Dartmouth Atlas report on pediatric health care notes that children in regions with fewer ambulatory office visits (visits for illness to their primary care office) were more likely to wind up in an ER and less likely to receive recommended care. In my opinion, this includes winding up in walk-in clinics where the care isn’t the same as in their primary care physician’s office.

So you may ask – what is a medical home? For pediatricians it includes the following provisions:

1. Offers family-centered care.

2. Shares unbiased medical information with patients.

3. Provides primary care for patients.

4. Provides care for acute illnesses on a 24/7, 365-day schedule.

5. Identifies the need for and refers patients to specialty care.

6. Interacts with early intervention services for developmental issues and care.

7. Coordinates care with other providers.

8. Provides a central medical record on patients.

9. Develops age- and culturally appropriate health care assessments.

These are the guidelines most pediatric practices and many other medical practices work hard to keep, and part of this concept is to provide care for illnesses that our patients experience.

The addition of walk-in clinics damages the medical home and fractionates the care of our patients.

One way of looking at it could be a day-care model. Your children may go to a regular day care where the teachers know them and can tell when their day is going well or not so well and can give you an accurate assessment of how your children have been doing because they are invested in your children’s well-being.

Now say one day you need to be at work earlier than the day care opens. Would you be comfortable walking into the other day care down the street and saying, “Would you watch my child today as his regular day care hours aren’t convenient for me today?” How confident would you be leaving your children in a strange place, and how comfortable would they be interacting with strange day-care workers under these conditions? Your day care has also become a “home” of types for your child.

Another issue is the prescribing of medications, especially antibiotics. Years ago most children going to the ER left with an antibiotic prescription even when the illness may have been viral. Our local ER has worked hard to make sure that antibiotics are only prescribed for bacterial illnesses and that unnecessary medical tests aren’t done on children. Our ER also has hospitalists available for consultation on pediatric patients.

How do we know these guidelines are being followed at for-profit walk-in care centers?

All the pediatricians in the Concord area have been working through the years with the Concord Hospital ER and urgent care at Horseshoe Pond to develop good patient care. We have no relationship with the walk-in clinics that are springing up all over, so we don’t even know what type of care they provide.

I would hope the parents of the Concord area would always contact their pediatric or family doctors before they go off to one of the new walk-in clinics. I have always felt that we did very well in this city with the support of our local ER and urgent care center and remain perplexed about why we suddenly require more walk-in clinics.

All the children’s doctors I’ve spoken with hope you will call us first.

We are first and foremost here to serve our patients and families. When we are on call, we expect to be called when you have a problem. You are not disturbing us – this is our profession and we really are here for you!

My comments reflect the thoughts of the pediatric community of Concord. It would be very interesting to hear how our family practice and internal medicine colleagues feel about the need for more urgent care centers in Concord.

(Dr. Patricia Edwards of Bow is a pediatrician and president of Concord Pediatrics in Concord.)

Legacy Comments5

I agree with Nelle, makes me wonder about financial incentive when a Concord Hospital practice refers me to Horseshoe Pond walk in for sprains, skin infections, or even stitches. Remember when stitches were done in the office? Has there ever been a review of the number of patients directed to CH walk in or ED by CH practices who can't see their own patients due to over scheduling? The difference between the charges for these visits is huge for us. This is just another example of how our healthcare costs increase to benefit the convenience of practices and hospitals. I welcome the addition of another walk in provider that has extended hours without an affiliation to a healthcare monopoly.

This has been headed this way for years. Today, they treat the symptoms, give innoculations and do physicals. Doctors seldom stitch you up or treat your wounds or breaks, they send you off to x-ray and they you go to specialists. The overall time a doctor spends with you during a physical is 30 minutes. You can't tell much in 30 minutes. I can remember as a child that my doctor treated anything that was wrong. Todays General Practice Doctors are generally about well care.

I'd prefer your model. With regard to care other than paediatrics, if my elderly mother calls her physician, she is inevitably referred to urgent care when it isn't necessary. I'd suggest physicians rethink when to direct patients elsewhere.

Agreed, when my elderly parents have an issue with breathing or other related issues, they call their primary care office just 7 miles away. They are always told to get to the emergency room at CH. They told them that the office is not set up to deal with such issues. Physicians used to be all about treating their patients now they are all about referring them elsewhere.

Same thing with my elderly mother, only her doctor was a 1 1/2 miles away and it was always go to Concord Hospital. Only difference in my view is that today the "family physician" acts a more of a triage Dr. deferring to specialists when it's not your every day cold or flu. And we wonder why healthcare is so expensive?

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