Convenient Ambulatory Care--Promise, Pitfalls, and Policy.

Every year, 1.2 billion visits are made in ambulatory care settings, accounting for approximately one third of health care spending in the United States.1,2 Although the vast majority of these visits take place in office-based clinics and emergency departments, an increasing number of patients are seeking care in nontraditional sites such as retail clinics and urgent care centers. Retail clinics are walk-in health clinics, typically located in pharmacies or supermarkets, that provide immediate care for a narrowly defined scope of services, such as the diagnosis and treatment of minor acute illnesses, as well as some preventive care and care for chronic conditions. Urgent care centers are also walk-in health centers, but they treat a wider range of acute conditions requiring immediate but not emergency care (Table 1). Both retail clinics and urgent care centers are part of the rapidly growing “convenient care” industry, which encompasses a broad spectrum of consumer-oriented innovations providing swift, easily accessible, and more affordable care.3,4 Some new convenient care approaches, such as electronic visits and telemedicine, allow patients to determine the locus of care. Retail clinics and urgent care centers represent convenient ambulatory care. Unlike traditional ambulatory care, retail clinics and urgent care centers operate almost exclusively on a walk-in basis and are often conveniently located in areas of high foot traffic within communities. Many also provide transparent pricing, with the menu and price of services often listed online, on site, or both. A confluence of factors — including expanded health coverage, lengthy wait times for primary care appointments, crowded emergency departments, and increasing health care costs — have stimulated considerable interest and investment in convenient ambulatory care in recent years.5-7 However, physician organizations such as the American Academy of Pediatrics and the American Academy of Family Physicians have expressed concerns about the potential for convenient ambulatory care to fragment care and provide lower-quality care.8,9 These debates have ensued with greater frequency in recent years as several states consider legislation around the practice of convenient ambulatory care. This article aims to further characterize retail clinics and urgent care centers; to examine the evidence of their effect on cost, quality, ac-