News

By Cheree Cleghorn, Editor

Last year, Wal-Mart stores announced that selected stores would have walk-in clinics with nurses available for minor problems and working under a doctor’s supervision.

Many health care professionals expressed concerns about the stores’ ability to deliver Doritoes in Aisle Three and flu shots in the back of the store. While this sounds tedious—-it is, but for good reasons— providing health care is not simply a matter of grabbing some space, hiring good nurses, ordering some supplies and displaying the sign prominently so shoppers can see it.

There are many health and safety requirements that doctor’s offices, immediate care centers and hospitals, among others, must meet. The first reports did not sound as if the Wall Mart executives had a handle on those.

For instance, how would they obtain, label and process urine samples properly when there is no designated place for that? Or other samples?

Would they be running the risk of infecting healthy shoppers what whatever is going around? Coughing in the rear, please.

And, the toughest question of all, how available would the doctors be to nurse practitioners? Nurse practitioners are highly skilled, master’s prepared nurses. In many states have broad privileges once restricted to doctors. In others, they do not yet. However, when a patient must have a doctor—-and that time will come—-how quickly can those nurse practitioners get the doctor on duty?

The money part is simple. These stores would have to be doing very, very high volumes to make having a doctor on-site feasible. If physicians are not on-site, where are they? How far away? Can the nurses get the kind of medical collaboration they need to protect their own licenses?

These are new questions for a new kind of care. Wal-Mart and the caregivers will be learning as they go.

In this New York Times story, Wal-Mart has announced a strategy for overcoming the concerns about cleanliness, access to medical supervision and other issues.

“We have learned that people are willing to receive their health care from the front of a store or the back of a drugstore,” said Dr. John Agwunobi, a medical doctor who is a Wal-Mart senior vice president. “But customers also have said they would rather it be delivered by a trusted name, a local health care practice, a trusted local provider of care,” the Times story says.

“Moving to upgrade its walk-in medical clinic business, Wal-Mart is set to announce on Thursday plans for several hundred new clinics at its stores, using a standardized format and jointly branded with hospitals and medical groups.”

Only experience will tell whether Wal-Mart clinics will compete with Immediate Care Clinics—-where doctors are full-time and handle problems which don’t belong in an ER but which may need attention promptly—-or whether Wal-Mart is developing a pre-Immediate Care Clinic track for the simplest problems. That is an important distinction. Wal-Mart may be inventing a new level of care.

Wal-Mart’s joining forces with local hospitals sounds like a move designed to overcome concerns about the adequacy of the facilties, staffing and other concerns. With a doctor shortage in the works, and a nursing shortage that will go on for decades, is this the best use of these professionals? We shall see when these clinics have a profile on the patients who come, why and what they needed. That will answer the question about how appropriate it is to divert nurses to store clinics.

These clinics may be the greatest idea since antiobiotics. Then again, they may not.

The scale on which these clinics are being established, hundreds of them, should produce a lot of information fairly quickly about who’s using them, why and how their follow-up care, if any, is coordinate with caregivers. 

Source: The New York Times, February 8, 2008