One in Four Kids Seen at Urgent Care, Retail Clinics in 2019

More children visited urgent care and retail health clinics in 2019 compared with years prior, but disparities related to which children are accessing these clinics are emerging, according to data from the National Health Interview Survey.

Nationally, 26.4% of children visited urgent care and retail health clinics, typically located in grocery stores or pharmacies, at least once in the past year, reported Lindsey I. Black, MPH, and Benjamin Zablotsky, PhD, of the National Center for Health Statistics (NCHS) in Hyattsville, Maryland.

Children with private or public insurance accessed care at one such clinic at similar rates (27.6% vs 25.2%), but uninsured children accessed them at lower rates (19.3%), the researchers wrote in an NCHS Data Brief.

“The level of convenience in accessing health care may be a factor for parents when choosing to seek care for their children at urgent care centers and retail health clinics,” Black and Zablotsky wrote.

The American Academy of Pediatrics endorses urgent care clinics as a “safe, effective adjunct to, but not a replacement for, the medical home or emergency department.” A pediatric committee of the American College of Emergency Physicians has also noted that when used properly, these centers can be “valuable and convenient,” and can potentially reduce emergency department (ED) wait times.

Most urgent care and retail clinics are staffed by at least one physician and run by nurse practitioners, physician assistants, or medical assistants. From 2006 to 2014, the number of retail clinics increased from 200 to 1,800.

Although it’s preferable to have kids be seen by pediatricians in their medical home, “convenience care” sites like urgent care and retail clinics are helpful for treating things outside the scope of an office setting, like a fracture or laceration, commented Amanda G. Montalbano, MD, MPH, of Children’s Mercy in Kansas City, Missouri, who was not involved in this research.

“There was some concern in the past that children seeking care at these sites may be getting less than ideal care, but we’ve been working hard in the pediatric urgent care community to reach out to retail clinics and offer pediatric expertise to them because they do serve as a convenience site of care for families who need to get a quick strep test or get kids back to school,” Montalbano told MedPage Today.

However, most convenience care facilities are located in suburban areas, and do not serve as an access point for rural or inner city areas, where they could potentially fill gaps in care, Montalbano noted.

In this study, children with parents who had more than a high school education were more likely than kids with parents who completed high school at most to access these clinics (28.1% vs 22.1%), as were children with family incomes above versus below 200% of the federal poverty level (28.1% vs 23.8%), the authors reported.

Hispanic and Black children were also less likely to have visited urgent care or retail health clinics than white children (22.6% and 24.9% vs 29.2%).

Residential areas with a lower “opportunity index” (reflecting socioeconomic and cultural deprivation) and discriminatory practices such as redlining may keep convenience clinics from being developed in certain communities, contributing to disparities in children’s access to such clinics, Montalbano said.

These sites may be advantageous for uninsured patients because they have been associated with reduced out-of-pocket costs. Retail and urgent care clinic costs for common conditions, for example, have been estimated to be hundreds of dollars lower than cases seen in an ED.

Downstream effects of waiting 24-48 hours to get a child checked out are also not insignificant for working families or those living with food insecurity, who rely on sending their child to school to get a reduced price lunch, for example, Montalbano noted.

“I would love to see [uninsured patients] seek care in lower acuity sites, not going to the ED, and getting care if appropriate at retail or urgent care centers because they can be more cost effective for the right types of chief complaints,” she said.

Regardless, she added, this snapshot of pre-pandemic urgent care and retail clinic usage will likely change as a result of many pediatricians and convenience clinics transitioning to telehealth.

“The ramp-up of telemedicine is going to change how, when, and where parents are able to access care for their children,” Montalbano said. “It’s going to be a game changer in how kids are triaged.”