The onset of swine flu has reignited the debate about whether retail-based, walk-in healthcare clinics are an appropriate venue for treating people with highly communicable diseases.
"Someone who is sick and goes into a retail setting is potentially putting all shoppers at risk," says James Milam, MD, a Vernon Hills, IL-based OB/GYN and president of the Illinois State Medical Society. "With a very communicable disease like this, people are being told to stay at home if they have a fever or a recent cough or those symptoms that are equated with swine flu. So, the last thing I would want if I were a shopper would be to have someone coming to get care at a clinic where I was doing my shopping."
William Briggs, president of the 36,000-member Emergency Nurses Association, raised similar reservations.
"Our concerns are that they have the adequate protections for staff and other clients when there is a flu epidemic,” Briggs says. "You’ve got to have the space to isolate them, to put a mask on, to have the right hand washing and disinfectants available, and that may not be present in a retail clinic.”
Briggs says it's also not clear if convenience care clinics are coordinating with local public health authorities to monitor the virus or send specimens to the state labs for confirmation. "To date, there is not a lot of regulation and oversight of these retail clinics,” he says.
Tine Hansen-Turton, executive director of the 1,250-member Convenience Care Association, dismisses Milam's concerns and says the retail-based clinics are proving to be "the first line of defense" in the effort to provide public access, diagnose the disease, answer questions, and allay concerns.
"We are a critical access point and we want to contribute like others to ensure that people are seen and taken care of," Hansen-Turton says. "We are there. We are in the community. We are close to where people live and we present a unique opportunity for people to get their concerns alleviated, and we provide a response to this healthcare threat."
Hansen-Turton says people with cold and flu symptoms already go to pharmacies for over-the-counter medications and advice, regardless of whether or not the pharmacy has a clinic. "They would have been there anyway because of their health needs, so we see this as an opportunity for them to be checked," she says.
Hansen-Turton says most, if not all, convenience care clinics have the ability to identify the Type A influenza with a nasal swab and provide a diagnosis within five minutes for patients who might otherwise have no access to a physicians office, or who can't afford an emergency room visit.
"We present an opportunity for people to be seen," she says.
Milam says the ISMS envisioned a scenario similar to the swine flu outbreak when it tried in February 2008 to get the Illinois General Assembly to pass a law requiring retail-based convenience clinics to have separate entrances, separate waiting areas for ill patients, separate bathrooms and sinks, and separate exhaust fans.
The bill failed, he says, because of pressure from the convenience care industry. "Our position hasn't changed," Milam says. "It seems counterintuitive to invite folks into a retail setting who have a very communicable disease," he says.
The Emergency Nurses Association and the American College of Emergency Physicians today issued a joint statement urging the use of a "prudent layperson standard" for people who suspect they may have swine flu.
"If you have symptoms that would not ordinarily take you to the emergency department but are considering going because you are afraid you have swine flu, you probably do not need to go," Briggs says. "Remember that many illnesses–not just swine flu–are transmitted in public places and very often the best way to avoid the spread of disease is to stay home until your symptoms subside."