Communication Is Key
Urgent care centers typically refer more complicated cases to specialists in the community, said Stoimenoff. “I think urgent care centers have been established to provide episodic care,” she said. “We need to remember that urgent care centers provide a great service to referring to specialists in the community, particularly with things like chronic allergies. It’s just like how a primary care physician would do it.”
Explore This IssueJanuary 2013
Such referrals are important, particularly when there’s communication between the urgent care provider and a specialist. “Urgent care centers are not going to go away; we just have to work with them,” said Dr. Doxey, who worked in such a facility for about a year between his residency and internship in 1981 and 1982, and again for a three-year stint before opening his practice 28 years ago.
“We need to communicate with [the referring urgent care health care provider], particularly if they made a wrong diagnosis, and follow up,” he said. “Someone who refers patients to a specialist should always get a letter. Sometimes, I’ll even phone because of the seriousness of the situation. They are interested in follow-up because that’s how they get better—by learning what the accurate diagnosis is.”
There is concern over the potential for antibiotic overuse at urgent care facilities. “One of my concerns about physicians who work in an ambulatory setting that is controlled by a hospital setting is that the M.O. is volume, not quality,” said Gary H. Lambert, MD, an emergency medicine doctor employed by Utah Emergency Physicians in Salt Lake City. “The simple fix is an antibiotic prescription, and patients are on their way. But most of sinusitis is allergic or viral in origin, and antibiotics don’t address this.”
But at least one study found that antibiotic use isn’t excessive at urgent care centers, said Stoimenoff. In “Health Care on Aisle 7: The Growing Phenomenon of Retail Clinics,” a 2009 study published by the RAND Corporation, researchers found that the number of antibiotic prescriptions given for people with otitis media were relatively close at urgent care centers, doctor’s offices, emergency departments and retail clinics, which are facilities that provide care similar to freestanding urgent care centers but operate out of established businesses such as pharmacies, grocery stores and “big box” stores like Target. Antibiotic prescriptions for sore throats were also consistent across facilities (see “Antibiotic Usage by Health Care Setting, below).