Walgreens Clinics Set A Precedent In Treating Chronic Conditions

July 12, 2013

Access to health care has long been a question with many answers -- none of them especially simple.

Walgreens This is the Walgreens where Marianne Rosati works, located at Tatum Boulevard and Cave Creek Road. (Photo by Nick Blumberg-KJZZ)

Just this week, Health and Human Services Secretary Kathleen Sebelius was in Phoenix to announce a huge pot of grant money to help out local health centers and help people understand one of the big provisions of the Affordable Care Act. It will be months before that kicks in and everyone has insurance, or at least, is supposed to.

In the meantime, one of the giants of retail health care in the U.S. has stepped up its services.

Nurse Practitioner Marianne Rosati walked around the Take Care Clinic she runs inside the Walgreens at Tatum and Cave Creek.

“This is the exam table. Our vaccinations are all kept in the refrigerator. This is where we keep all of our sharps," Rosati said.

This is one of 22 Take Care Clinics around the Valley and one of hundreds around the country that has started diagnosing and treating chronic conditions as well as acute ones. Acute conditions are things like strep or bronchitis or a UTI. For now, Walgreens is the first retail health clinic to treat chronic conditions, like...

“Hypertension, diabetes," Rosati said.

Rosati Nurse practitioner Marianne Rosati works at a Walgreens and is happy to be able treat chronic conditions now instead of just acute ones. (Photo by Nick Blumberg-KJZZ)

Plus high cholesterol and asthma. Rosati is really excited about providing this kind of care. Instead of just treating somebody who is having an asthma attack, now she can help them to understand their condition and get them on a treatment plan. Rosati said a huge chunk of the patients that come into her clinic have not seen a doctor in years.

“And they tell us regularly if it weren’t for us, they would not get care, and one of the challenges is to get them into the primary care model, and we work really hard with them, and we try to work with the local physicians," Rosati said.

And that is a very important point for Rosati and for Walgreens. Even though Take Care Clinics will now diagnose and treat chronic conditions, they also are supposed to help the patient get set up with a primary care doctor.

Jon Ford with St. Luke’s Health Initiatives said it is hard to know how the expanded services at Walgreens clinics will play out.

“You’re giving them, generally speaking, lower costs on an apples-to-apples comparison. There are other aspects of this, mostly related to quality of care and continuity of care, where you start to wonder whether or not it is a good idea," Ford said.

clinic Marianne Rosati works in this clinic at the Walgreens on Tatum Boulevard and Cave Creek Road. (Photo by Nick Blumberg-KJZZ)

Whether it is advisable does not seem to affect the popularity of these clinics. Studies show more and more Americans are using them for reasons like the convenient hours, locations and the transparency of the bills. But while a lot of patients like retail health clinics, Ford said doctors might not.

“A physician will certainly feel as though you have cheated on him or her if you go to a clinic hoping to take your own care into your hands," Ford said.
“Chronic conditions really require, I think, a long-term committed relationship with a primary care doc.”

Tom Rothe is a family practitioner in Tucson. He has been a doctor for 33 years, and he is the current president of the Arizona Medical Association.

“Chronic medical conditions are and can be complicated. Often they coincide with other chronic medical problems, so you really need to have someone who has a breadth of experience seeing these things to, I think, appropriately take care of them," Rothe said.

Rothe does sees a place for Take Care Clinics and others like them, to provide care when a doctor’s office is closed, or to give out flu shots. But he says companies like Walgreens and Wal-Mart see they can pull in a lot of patients, which can mean big money.

Ford John Ford of St. Luke's Health Initiatives is not sure how the Walgreens clinics will play out. (Photo by Nick Blumberg-KJZZ

“People are there buying groceries, and well, let’s see, 'we’ll drop the kids off so they can get their shots and meet me in aisle 10 for the potato chips,'" Rothe said. "Certainly there are some things that would be beneficial. I do not think that chronic care is one of them.”

And there is one more big wrinkle to this whole story.

“We are at probably the most awkward moment in health care history of the last 50 to 60 years," Ford said.

In a few short months, the health care reform law will kick in, providing millions more Americans with health coverage. Newly insured people who once went to Take Care Clinics may start seeing a primary care doctor instead, but one expert has speculated that as more people try to access an already too-small pool of doctors, retail clinics like the ones at Walgreens could be there to fill the gap.