In our area and across the country, private companies are opening and managing health clinics in retail, drug and grocery stores, including Target, Wal-Mart, Rite Aid and CVS. With names like Family Express Care, Minute Clinic and FastCare, these clinics offer a speedy visit with a nurse practitioner or physician's assistant for a limited number of basic medical services. Locally, Take Care Health Systems L.L.C. has opened clinics in Eckerd drug stores.

Dr. Terence W. Starz is president of the Allegheny County Medical Society (starz@acms.org).

Why is this new type of health-care delivery being introduced? In-store clinics are based on a business model that views patients as customers and health care as a commodity situated in an environment that allows consumers to purchase other products while tending to their medical needs. One of the primary motivations is to generate business for the outlet and its pharmacy.

Federal health laws prohibit pharmacies from operating their own clinics so they are leasing with outside companies to establish health clinics that can address basic medical needs on a walk-in basis and offer the option of having a prescription filled just a few steps away. Are grocery stores and pharmacies really where patients want to have their health care delivered -- or is this movement an indication of declining access to quality health care?

The principal selling point of retail health clinics to consumers is convenience. In some cases, customers don a paging device and shop for shampoo and other sundries while waiting to see medical professionals at the clinic. Because these clinics have weekend and evening hours, they can reduce the need to visit an emergency room for routine care when a physician's office is closed. They also boast affordability. Some insurers waive or reduce co-payments for services at retail health clinics.

In-store clinics deal with a short list of treatable ailments, including strep throat; ear, sinus or bladder infection; influenza; several skin conditions; pregnancy testing and various vaccines. Clinic practitioners are qualified to write medically appropriate prescriptions, but not those requiring ongoing care, such as contraceptives, antidepressants and heart medications.

While consumers can obtain certain diagnoses and treatments at retail health clinics, there is one thing they cannot get -- an examination by a physician. Retail clinics typically use physicians, often from a remote location, to supervise the nurse practitioner or physician's assistant who provides the actual care. Some clinics also use software and protocols that assist in making diagnoses and treatment plans. Fortunately, some clinics notify primary care physicians or recommend a physician to be contacted when continued care is necessary.

Overall, nurse practitioners and physician's assistants are well trained and skilled, and they provide a great service in doctors' offices. However, in a setting where a physician is not present to examine patients, there is a risk of an inaccurate diagnosis or of missing a serious medical condition. Seemingly "simple" cases often aren't simple. Physicians spend years studying and practicing medicine to discern whether an apparently "simple" symptom indicates a more significant problem. Moreover, unforeseen complications from an ailment or from its treatment could result in an additional visit to an emergency room or a physician's office, resulting in another round of screening, testing and treatment.

Requirements for physician supervision of retail health clinics vary from state to state. Pennsylvania likely will consider retail health clinics as an extension of a physician's office, and regulations governing the supervising doctors probably will come from the Bureau of Professional and Occupational Affairs rather than the Department of Health, which regulates specialty clinics such as imaging, dialysis or drug rehabilitation centers.

Follow-up care is another concern with quick-stop clinics. Visiting a retail health clinic in a pinch should not replace having a primary care physician oversee a patient's overall care. Quick care is not the same as primary care. The physician-patient relationship is significant in terms of continuity of care and establishing a "home base" for a patient's medical history. In addition, most practices are affiliated with a larger health care system and have a physician on call for after-hours emergencies. Physicians practice with patient care as their first priority.

Before considering a retail health clinic, patients should conduct the same research they would in selecting a physician. Find out the name and location of the physician or practice that supervises the clinic staff and learn how often and the means by which they monitor the clinic -- by telephone, computer or onsite visits. Ask clinicians for their credentials. Understand the clinic's diagnostic and treatment offerings and request a list of physician referrals, in case your medical need goes beyond the clinic's range of services. Beware of clinics that "self-refer" patients to products and services (e.g. the pharmacy) that are situated a few feet away. Check if the clinic communicates patient information to primary care physicians.

When used appropriately as a supplement to primary and specialty care, retail health clinics can allow patients to save some time and perhaps some money when certain non-emergent medical situations arise. However, they should not be considered an alternative to the continuity of care established through an ongoing doctor-patient relationship with a primary care physician.