Pediatricians say a revised policy by the American Academy of Pediatrics that emphasizes collaboration between physicians and retail-based clinics is a necessary shift as the clinics expand and grow in popularity.

The 2014 policy maintains its stance established in 2006 that retail-based clinics (RBCs) are an inappropriate source of primary care for children, but now maintains that partnerships among pediatric medical homes and retail clinics are essential if such clinics are needed to expand acute care access in a given community.

"It is important to still emphasize that the best care for children is delivered within the medical home," Dr. Lee Savio Beers of Children’s National Medical Center, Washington, said in an interview. "That said, there are situations and communities where RBCs can play a role in making sure children have access to care, particularly during after-hours times. In these situations, good collaboration between the RBCs and the primary care medical home is of the utmost importance in order to ensure the best and most comprehensive care for children."

The revised policy is a fundamental change from the AAP’s 2006 position of opposing all RBCs as a source of pediatric care. The new policy stresses that both the medical home and the RBC should develop a formal collaborative relationship in the event that pediatricians and the pediatric medical home need to use the services of an RBC. The policy indicates the necessary criteria of that relationship, including prompt communication with the pediatric medical home for all RBC visits, referral of patients back to the pediatric medical home or the establishment of a medical home, and formal arrangements for after-hours coverage or emergency situations that may occur during an RBC patient visit (Pediatrics 2014;133:e794-7 [doi 10.1542/peds.2013-4080]).

In a statement, the academy said RBCs do not provide children with the high-quality, regular preventative health care that they require, but that it is understood that the services of these clinics may be used for acute care outside the medical home. More than 6,000 RBCs have opened since their 2000 inception, and research shows 15% of pediatric patients will visit a retail clinic in the future.

"The landscape of how medical care is delivered and the continued emergence of large systems of care potentially creates an opportunity for RBCs to work with local pediatricians and utilize them as the partner to expand access to care for children and still function in a coordinated and cooperative way," said Dr. James J. Laughlin, lead author of the revised AAP policy and a Bloomington, Ind.–based pediatrician.

This policy does not cover freestanding urgent care clinics, which are addressed in a separate AAP policy statement.

Pediatricians say they are open to the idea of developing partnerships with RBCs, although some have not yet had the opportunity.

"In our area, we have not yet had to forge those relationships," said Dr. David Hill, vice president of Cape Fear Pediatrics in Wilmington, N.C., and professor of pediatrics at the University of North Carolina at Chapel Hill. "However, if we do see an influx of RBCs, we’re going to want to reach out to them proactively and ensure rapid and complete communications between their offices and ours."

Dr. Beers also has not seen a need to develop relationships with RBCs, but said the partnerships appear to be valuable in rural areas.

"We advise our patients to always call us first so that we can help them think through if they need to be seen outside the medical home and help facilitate access to care in our own clinics if needed," said Dr. Beers, chair of the AAP Committee on Residency Scholarships.

The AAP policy encourages pediatricians to offer accessible hours and locations to provide patients the convenience they prefer.

Dr. Hill’s practice already has instituted these benefits to compete with urgent care centers and emergency departments, he said.

"This year has started out for us with low patient volume, and we are responding by adding evening hours and starting to schedule well-child exams on Saturdays," said Dr. Hill, chair-elect of the AAP Council on Communications and Media.

"We’ve also added walk-in hours in the mornings and opened a new clinic. In the past, we’ve always been able to rely on providing a higher quality level of care than RBCs. Now we’re going to have to compete with them on convenience as well."

But Dr. Hill notes that RBCs as pediatric care providers are an inevitable part of the future.

"Change is a constant in pediatrics, just as in all other fields," he said. "We can shake our fists at the heavens, or we can work hard to adapt and thrive in the new environment."

Lucas Franki contributed to this report.

AAP moves toward collaboration with retail-based clinics