From the Department of Internal Medicine, Division of Geriatrics (NOA, MAR), Sealy Center on Aging (MAR, YFK), School of Medicine (NH), and Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX (MAR, YFK).
J Am Board Fam Med. 2019 Jul-Aug;32(4):531-538. doi: 10.3122/jabfm.2019.04.180349.
We examined the relationship between retail clinic use and primary care physician (PCP) continuity among Medicare enrollees in the Houston metropolitan area.
We identified retail clinic providers in the study area using a 2015 health care provider database. Medicare claims data from enrollees who received care from retail clinics in 2015 were compared with propensity score-matched sample of enrollees who received no care from retail clinics.
There were 2.32 retail clinic visits per 1000 beneficiaries in a month. Approximately 1.3% of Medicare beneficiaries used retail clinics. Retail clinic users were more likely to be aged 65 to 74 years, female, White, and Medicaid ineligible. In multivariable analyses with adjustments for covariates, significant predictors of retail clinic use included having ≥3 chronic conditions (Odds Ratio [OR], 1.53 vs no condition), living within 1 mile of a retail clinic (OR, 2.44 vs living ≥5 miles), and having no PCP (OR, 1.11 vs having PCP). Compared with propensity-matched controls, among enrollees with an identified PCP, likelihood of seeing their PCP (OR, 0.82; 95% CI, 0.73 to 0.93) and continuity of care was lower (0.75 ± 0.33 vs 0.80 ± 0.31) if they had retail clinic visits.
Retail clinic use was lower in the elderly population compared with the previously published rate in the younger populations. The lower rate of continuity of care observed among retail clinic users is concerning, especially for those with chronic medical conditions.
我们考察了休斯顿都会区医疗保险参保者中零售诊所的使用与初级保健医生（PCP）连续性之间的关系。
我们使用 2015 年医疗服务提供者数据库确定了研究区域内的零售诊所提供者。将 2015 年在零售诊所接受治疗的参保者的医疗保险索赔数据与未在零售诊所接受治疗的参保者的倾向得分匹配样本进行比较。
每月每千名受益人的零售诊所就诊次数为 2.32 次。大约有 1.3%的医疗保险参保者使用零售诊所。零售诊所使用者更可能年龄在 65 至 74 岁之间，女性，白人，不符合医疗补助资格。在调整了协变量的多变量分析中，零售诊所使用的显著预测因素包括有≥3 种慢性病（优势比 [OR]，1.53 比无疾病），居住在零售诊所 1 英里内（OR，2.44 比居住≥5 英里），以及没有 PCP（OR，1.11 比有 PCP）。与倾向得分匹配的对照组相比，在有确定 PCP 的参保者中，如果他们有零售诊所就诊，那么看他们的 PCP（OR，0.82；95%CI，0.73 至 0.93）和连续性护理的可能性较低（0.75±0.33 比 0.80±0.31）。
与之前在年轻人群中发表的比率相比，零售诊所的使用在老年人群中较低。观察到的零售诊所使用者的护理连续性较低令人担忧，特别是对于那些有慢性疾病的人。
