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Urgent care centers can support, not replace pediatricians: docs

By Andrew M. Seaman

NEW YORK (Reuters Health) - Urgent care centers can provide care for young people who are mildly or moderately sick or injured, but the centers should not replace children’s so-called medical home, according to a leading group of pediatricians.

When urgent care centers do treat young patients, their staff should communicate with the children’s primary care providers, the policy statement from the American Academy of Pediatrics (AAP) adds.

“I think that one of the underlying messages is that urgent care centers are an important place for children to get urgent economical and acute care, but there is very little research out there,” Dr. Gregory Conners said.

Conners is the lead author of the new policy statement, which is published in the AAP journal Pediatrics. He is also vice chair of pediatrics for emergency and urgent care at Children’s Mercy Hospital in Kansas City, Missouri.

Urgent care centers are usually freestanding clinics that provide services for a range of ailments from stomach aches to broken bones. The centers typically step in when doctors’ offices are closed or no appointments are available.

There were approximately 9,000 such centers in the U.S. providing care to over 160 million people in 2013, according to the Urgent Care Association of America.

The cost of a visit to an urgent care center depends on its owner and the patient's condition and insurance (see Reuters story of June 11, 2013 here: http://reut.rs/QVHPLF.)

Urgent care centers differ from the retail clinics found in many pharmacies. The AAP recommended earlier this year that children not receive primary care from retail clinics (see Reuters Health story of February 24, 2014 here: http://reut.rs/QUWCX2).

The AAP team writes that well-managed urgent care centers can be integrated into communities and enhance children’s care. They can provide safe and effective care, but not replace children’s primary healthcare teams - known as medical homes.

The organization recommends that urgent care centers set a scope of care that outlines what they can and should provide to children. But the centers should be prepared for emergencies, too.

“I’m not saying urgent care centers should be ready to manage all emergencies, but they need to be able to start care while they’re dialing 911,” said Conners, who oversees three urgent care centers.

The centers should integrate themselves with the local system of care, which includes health departments and medical societies. They should also have transfer agreements with area hospitals that provide emergency care.

Conners said the statement authors also recommend that staff have the training to manage children’s care, in particular.

“There is enough specific knowledge that it’s necessary,” he said. “You can do adult and pediatric care but you have to be as good with pediatrics as with the adults.”

The centers should also collaborate with local primary care doctors to make sure documents and other communications are promptly transferred.

“The AAP is really supportive of the medical home concept,” Conners said. “I think this statement is really in line with that.”

Dr. Robert G. Graw Jr. told Reuters Health that, for the most part, urgent care centers are not trying to compete with or provide primary care. “What they’re really trying to do is supplement those doctors,” he said.

Graw, a pediatrician, is chief executive officer of Righttime Medical Care, a group of urgent care centers near Annapolis, Maryland.

He said parents can trust urgent care centers.

“Urgent care clinics have matured and give trustworthy care at times when their private physicians are not available, but they integrate their care with what their physician needs to know,” he added.

SOURCE: http://bit.ly/QVhPQt Pediatrics, online April 28, 2014.

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