You have a cold and a nagging cough. It's 5:02 p.m. Your doctor's office just closed. What do you do?
You could go buy some industrial-strength Mucinex and try to tough it out through the evening, but more likely these days, you'll find yourself in a "retail clinic," a tiny space staffed by a nurse practitioner or physician's assistant who treats simple illnesses such as colds and ear infections and provides services such as routine vaccinations and school physicals.
Two factors make in-store clinics a health care development to watch in the Bluegrass State. First, the Affordable Care Act will extend health insurance to millions of people who are not now covered. Second, according to the Kaiser Foundation, Kentucky is full of areas where primary care is scarce.
Tina Hansen-Turton of the Convenient Care Association — a group that includes companies that operate about 1,450 retail-based clinics — wrote in an email that patient visits at the clinics have passed 20 million.
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More than half of patients who use retail clinics do not have a primary care physician, Hansen- Turton wrote, and "even patients who do have a primary care physician are often unable to get an appointment when they need one."
The retail clinics are not only looking at expansion of their numbers, but looking to grow the services they offer. Hansen-Turton thinks the clinics could expand to care for diabetes, hypertension and high cholesterol.
The possibility of expanding such services was echoed by David J. Bensema, executive director of physician services at Baptist Health Lexington, formerly Central Baptist Hospital.
He said that state restrictions do not allow Baptist Express Care clinics to provide follow-up care or case management for conditions such as diabetes.
Nonetheless, he said the 18 Baptist Express Care clinics in Kentucky showed year-over-year patient volume growth of 190 percent.
"The consumer mood throughout the country is that folks would like to see that type of primary care offered in these more accessible settings," he said. That will only intensify as the Affordable Care Act funnels more patients into the system, he said.
Jim Cohn, a spokesman for Walgreen's, said the drugstore chain was pleased with its 10 Kentucky clinics — all in the Northern Kentucky and Louisville areas — but had "no definitive plans" to expand within the state.
"Both Louisville and Cincinnati have been really good markets for us," Cohn said, adding that the chain is "continually evaluating which markets and services would be most valuable."
But Dr. Brent Wright, vice chairman of the board of trustees for the Kentucky Medical Association and a practicing family physician in Glasgow, said he didn't think the mini-clinics were a solution to Kentucky's spotty primary care.
"The solution that going forward needs to be focused on most clearly is the patient-centered medical home," he said, where physicians, nurse practitioners and other medical professionals collaborate on a patient's continued care. "I look at these clinics as the fast food of medicine. I don't think there's any doubt what fast food means to the health of the nation."
Wright said that while Kentucky has a need for expanded primary care, the state should study other options — some of them involving the use of technology for doctor-patient communication — to connect patients with medical help.
Of the mini-clinics, he said, "Yes, they provide a service. Do they provide optimal patient care within a patient-centered medical home? I think the answer is no."
The retail clinics do not require appointments and accept a variety of insurance plans. The retail clinics provide a clear price list for their services for cash clients and those who do not have insurance. And, unlike the variable wait times at doctors' offices, where physicians might see patients with anything from ailing kidneys to creaky joints, retail clinics pride themselves on quick service for limited illnesses.
At a clinic operated by Baptist Express Care inside a Wal-Mart, you can get your bronchitis diagnosed, drop off a prescription and walk out with the prescription, a can of chicken soup and a fluffy new pillow in less than an hour.
With its locations at Wal-Mart, said Baptist Health Lexington executive William Sisson, "You don't have to worry about being sick on Sunday afternoon. It keeps people out of the emergency rooms that don't need to be there."
The drugstore chain CVS does not operate any of its Minute Clinics in Kentucky — the closest is in Jeffersonville, Ind. — but nonetheless the clinics are poised to expand from 625 in the United States now to about 1,500 by 2017 in an aggressive expansion plan, said spokesman Brent Burkhardt.
It's unclear if any of those will be in Kentucky.
Kirsten Halloran, a spokeswoman for Target, said its 54 clinics are performing "to expectations" but won't be immediately expanding to the commonwealth.
"We don't have plans to share at this time," she said.
Target Clinics operate in Minnesota, Maryland, Illinois, Florida, Northern Virginia and North Carolina.