James R. Johnson, MD
Potential Conflicts of Interest:Consultancies: Ortho-McNeil. Grants received: Bayer, Wyeth, Procter & Gamble, Merck.
Johnson JR. Comparing Costs and Quality of Care at Retail Clinics With Those of Other Medical Settings. Ann Intern Med. 2010;152:266-267. doi: 10.7326/0003-4819-152-4-201002160-00021
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Published: Ann Intern Med. 2010;152(4):266-267.
TO THE EDITOR:
Although intended primarily as a comparison of retail clinics with other medical settings, the study by Mehrotra and colleagues (1) incidentally documents disturbing lapses in management of urinary tract infections in the comparison standard. Thus, the observed noninferiority of retail clinics says less about the adequacy of these clinics' performance than about the inadequate performance of the traditional care settings studied. Specifically, in the physician office, urgent care, and emergency department groups, more than 40% of high-risk patients had no urine culture done (despite the known greater diversity of pathogens and higher likelihood of antimicrobial resistance in such patients), antibiotics were prescribed for longer than 7 days for more than 40% of patients with uncomplicated cystitis (in whom high-quality evidence supports 3-day therapy ), and more than 40% of patients with complicated urinary tract infections received less than 7 days of therapy (whereas expert opinion and some clinical trial evidence support longer treatment durations). Little comfort is provided by knowing that retail clinics are not doing any worse than traditional care settings for management of urinary tract infections when the traditional settings are doing so poorly; on the contrary, the latter finding is quite concerning.
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