Meghan Ross, Associate Editor

With as many as 1 in 12 US residents having asthma, retail clinicians are primed to help this patient population manage their chronic condition.

Patients are increasingly visiting physician assistants (PAs) and nurse practitioners (NPs) at retail clinics for asthma treatment, especially because of the anticipated

Almost 65% of adults with asthma have persistent asthma, while 35% have intermittent asthma, according to the US Centers for Disease Control and Prevention (CDC).

Kristen Marjama, DNP, FNP-BC, education and training manager with Walmart Care Clinics, shared the following 4 tips for optimizing asthma management.

1. Find ways to overcome barriers to asthma management.

Dr. Marjama identified a few challenges in helping patients manage their asthma, including time. Clinicians just do not have adequate time to educate their patients in many cases. They may also have issues finding privacy consultation space and administrative support.

She suggested that retail clinicians can overcome these barriers by focusing on strategizing in each individual clinic. Clinicians can then better focus on which patients are at risk, make time for education, work collaboratively, and provide feedback on what works and what doesn’t.

2. Dispel asthma treatment misconceptions and correct errors.

Patients with asthma may need some more information about the differences between short- and long-acting medications.

Dr. Marjama pointed out that some patients may say their long-acting bronchodilators do not work as well, but retail clinicians can tell these patients that they might not necessarily feel them working. The long-acting treatment should control their asthma levels so that they do not have to use their short-acting bronchodilators as much for acute symptoms.

“Our technical features are getting better, but if a patient doesn’t know how to use them correctly, they’re not going to get the medication into their lungs,” Dr. Marjama said.

Three common errors that patients make when using inhalers are that they do not exhale before inhaling the medication, they do not hold their breath for 5 to 10 seconds to allow the medication to settle into their lungs, and they do not rinse their mouth after inhalation.

Retail clinicians can remind patients about these techniques so that they get the right amount of medication in their lungs to be effective.

3. Check in with patients about asthma symptoms.

Clinicians need to know when and which asthma medication to prescribe to their patients.

For those with intermittent asthma, a short-acting beta-agonist used from time to time will be their best bet.

“The problem is, many times, they are using it way more than they should, and that goes unrecognized by health care providers,” Dr. Marjama said.

To correct this, retail clinicians should make sure to ask about nighttime and daytime symptoms, coughing, and wheezing, just in case the patient needs to take the next step up in therapy and start a controller medication. This way, patients will reduce their risk of scarring or permanent loss of lung function.

4. Reinforce the need for a written asthma action plan.

Dr. Marjama maintained that one of the most important things clinicians need to consider when treating patients with asthma is to check that they have a written asthma action plan.

Studies show that fewer than 25% of patients who need an asthma action plan don’t have one, according to Dr. Marjama.

Health care providers may not be giving plans out, patients may not be sure how to use the plan, or they may just be resistant to it. However, clinicians can help by asking them if they have a written plan and are using it.

“Patients don’t think it’s even important from a health care provider’s perspective,” Dr. Marjama said. “The more we ask questions about it, the more they know ‘I need my action plan.’ Action plans help them know what to do, how to manage their asthma, and what to do when their asthma worsens.”

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With as many as 1 in 12 US residents having asthma, retail clinicians are primed to help this patient population manage their chronic condition. 

4 Ways Retail Clinicians Can Optimize Asthma Management

With projections of physician shortages ranging from 46,000 to 90,000 in the next decade, patients could be left with gaps in their care. That’s where retail clinics come in.

The increasing demand for primary care is fueled in part by the millions of Americans newly insured under the Affordable Care Act, as well as the baby boomer generation reaching old age.

The Association of American Medical Colleges estimates that there will be a shortage of primary care physicians totaling anywhere between 12,500 and 31,100 in the next 10 years. Meanwhile, the US population will increase by about 30.8 million by 2025, and the number of Americans over 65 will increase by 46%.

“The impending physician shortage is an opportunity to move to a health care model where the physician can be more of a quarterback on a team of health care providers, rather than being on the front lines,” David Gorstein, managing director of Health Innovations, told

If primary care physicians are the quarterbacks, then nurse practitioners and physician assistants at retail clinics can be the back-up quarterbacks.

Self-employed patients without health insurance and those who would have to wait several weeks to get an appointment with their primary care physician can head over to their local retail clinic to seek more immediate care.

Patients like retail clinics’ transparent pricing and low costs in general,

noted. Weekend and late-night hours also attract patients. Furthermore, retail clinics are well-equipped to handle chronic diseases such as diabetes or asthma.

Don Goldmann, chief medical and scientific officer at the Institute for Healthcare Improvement, told

that retail clinics play an important role on the health care team and provide “easier access to providers and quick, convenient care.”

A recent report from Manatt Health determined that retail clinics’ long-term impact will depend on their ability to integrate into the health care team and their economic realities.

Key findings from the Robert Wood Johnson Foundation study included raising awareness that retail clinics can be a good alternative to the emergency room for after-hours care, and that they are adept at routine primary care, especially vaccinations, for children older than 18 months.

The report also suggested that clinics should work with their state and local governments to open new facilities in underserved communities. These retail clinics could help provide health insurance enrollment assistance, nutrition, and even housing support.

According to a 2010 health tracking household survey, the main reasons families chose a retail clinic in the last year were convenient hours, no need to make an appointment, convenient location, lower costs, and no usual source of care.

The report praised several retail clinics’ foray into chronic care programs. For example, MinuteClinic offers diabetes management that provides biometric screenings such as glucose, hemoglobin A1C, blood pressure, weight and foot exams, and weight management counseling programs. MinuteClinic also offers asthma maintenance therapy education.

Likewise, Walgreens’ Healthcare Clinics offer treatment and management for hypertension, high cholesterol, and asthma.

The study authors highlighted how one retail clinic’s emphasis on chronic care contributed to a rise in the percentage of visits for screening and management of chronic conditions from 4% in 2007 to 17% in 2013.

“As the nation’s health care system enters a period of profound change, these clinics offer an important locus of patient access within large retail establishments,” the study authors wrote.

Retail clinics are currently available in 40 states plus Washington, DC.

With projections of physician shortages, patients could be left with gaps in their care. That's where retail clinics come in.

How Retail Clinics Will Help Resolve the Physician Shortage

The fastest-growing provider of retail clinics has another feather to put in its cap, as CVS Health’s MinuteClinic has expanded to 1000 locations nationwide.

This milestone was marked by the opening of a MinuteClinic in Washington, DC, according to a CVS Health

. A previous release from CVS Health noted that the company expects to operate 1500 retail clinics by 2017.

The walk-in clinics are currently located in 31 states, plus DC, and they provide care for more than 26 million patients.

MinuteClinic Chief Nurse Practitioner Angela Patterson, MS, FNP-BC, told

that the company’s expanded footprint “enables us to increase access to quality, affordable, convenient health care (and) support population health and public health initiatives not only locally and regionally, but also on a national scale.”

“We’re really excited about hitting the 1000 clinic mark. For us, it’s a huge milestone and exemplary of our commitment to expanding access to affordable, convenient, quality care…in a way that has reach for many more millions of Americans,” she said.

MinuteClinic has several goals that include initiating new services, expanding telehealth services, and increasing clinical collaborations with more than 60 health-system affiliates.

“Whether it’s treating patients in urban centers like Washington, DC, or developing new ways to deliver care in other settings, the MinuteClinic mission to provide accessible health care will continue to evolve,” said Andrew Sussman, MD, MinuteClinic president and CVS Health executive vice president/associate chief medical officer, in a press release.

As the United States faces a shortage of primary care physicians, retail clinics like MinuteClinic will be stepping in to help provide care to patients,

Some of the services that MinuteClinic currently provides are prescriptions for common illnesses; treatment for minor wounds, skin conditions, and abrasions; and vaccines. The clinics also offer walk-in availability for sports and college physicals, plus wellness services designed to help treat diabetes, high blood pressure, and high cholesterol.

The company’s first retail clinic opened 15 years ago.

Additional reporting by Katie Eder, Senior Editor

The fastest-growing provider of retail clinics has another feather to put in its cap.

Meghan Ross, Associate Editor

Articles

4 Ways Retail Clinicians Can Optimize Asthma Management

How Retail Clinics Will Help Resolve the Physician Shortage

MinuteClinic Celebrates 1000 Retail Clinic Locations