Express-Checkout Diabetes Care?

I wonder, does your local shopping mall or drugstore contain a so-called Retail Clinic — a mini-health clinic where nurse practitioners provide walk-in treatment for very basic health issues? I haven’t experienced one in my neighborhood, but I am told there are now more than 500 around the country, in stores like Target, Wal-Mart, and CVS, with forecasts of more than 1,500 coming by the end of 2008.


Some of the leading chains are MinuteClinic, MedExpress and Take Care Health Systems, recently acquired by Walgreens. They typically treat “common family illnesses, such as strep throat, bronchitis and ear, eye and sinus infections.” But some clinics will also handle skin conditions, minor injuries, vaccinations, and annual physicals. Some advantages:

  • No appointment necessary
  • Open 7 days a week
  • Most insurance accepted, i.e. your regular co-pay arrangement
  • Flu shots offered daily
  • Extremely successful thus far, these retail-based health clinics “have captured the attention of the media, public, investors, and the medical establishment.”

    So what do you all think about a MinuteClinic concept for diabetes? Seems to me it would extremely helpful in particular for the millions of Type 2 patients who have trouble getting the treatment and guidance they need — usually due to access issues.

    At least one revered expert in diabetes education agrees. Check out this glowing feature on Dr. Linda Siminerio of the University of Pittsburgh Diabetes Institute. The article specifically points out:

    “Centers for diabetes education and management could be established based on the MedExpress model, where people can walk in for service when needed. Such centers could be placed in malls or Wal-Mart stores… Pharmacists and nurses could serve as educators and answer questions about medications, testing equipment, diet and exercise. Nurses could be trained to adjust medications and suggest lifestyle changes for people struggling with control. For now, doctors must make those decisions.”

    Dr. Siminerio rolls this up with her overall campaign to get healthcare plans to put more money into diabeates educational resources.

    Speaking of doctors currently calling all the shots (bad pun unintended), I was chatting lately with David Kibbe, MD, head of the American Academy of Family Physicians (AAFP) Health IT Center, about the sad state of diabetes education among primary care physicians, who end up treating most patients diabetes in this country by default.

    Kibbe says: “Seven minutes with your primary care physician isn’t going to cut it. The doctor needs at least 2-3 minutes to figure out what’s going on with that patient and why they’re there. And the doctors who take time with patients for diabetic counseling sacrifice income, because they’re not compensated for this.”

    So what about a new business model in which specialized convenience clinics offer low-cost diabetes care? There sure would be quite a market for it, with estimates of 50 million Americans with diabetes by the year 2020 (!) Who is going to help all these people manage their disease?!

    And wouldn’t it be great to have a one-stop shop for basic diabetes tests (A1c, lipids, microalbumin) and medication and nutritional advice, conveniently located right there where you do the rest of your shopping anyway? Sounds like a good option to me.


    8 Responses

    1. Major Bedhead
      Major Bedhead October 11, 2007 at 7:57 am | | Reply

      It does sound like a good idea, although the thought of Wal-Mart doing my health care kind of scares the crap out of me.

    2. CrazyACpumper
      CrazyACpumper October 11, 2007 at 9:52 am | | Reply

      When I lived in Philadelphia, a local supermarket chain had a pharmacy in their store. Within the pharmacy was FREE (yes, free) appointments with a Diabetes Educator. Her name was Angela and she was a saint! She helped me with SO much! I could vent, complain, take knowledge tests to see where I need edto improve my management, discuss nutrition etc etc.
      This did not replace my regular visits to the Endo but they communicated together. I could also email and call Angela if something came up.
      Besides working with the local ADA to start a Type 1 support group in my area, what I had in Philly is my ultimate goal for where I live.
      Right now I go to the local Joslin where Endo, Educator and Nutritionist are all in one. BUT, I have to pay for EACH visit. With no insurance?! Yea, I am still trying to find cheaper pump supplies….

      What a lifesaver it was! (Get food, scrips and talk to my Educator!)

    3. CrazyACpumper
      CrazyACpumper October 11, 2007 at 9:53 am | | Reply

      Oops, hate to comment again but I am a perfectionist….scrips should be scripts…. ;-)

    4. riva
      riva October 11, 2007 at 12:00 pm | | Reply

      For those of you in New York City, Duane Reade, a drug store chain here, has a diabetes educator in a few of its stores. Not sure if the cde is there all the time, or may just offer a weekly class. It’s a start, and worth looking into if you have need.


    5. RichW
      RichW October 11, 2007 at 1:29 pm | | Reply

      Centers for diabetes education and management; again you’re on to something. It’s a great idea. The pharmacy is a great place for it.

    6. vicki
      vicki October 11, 2007 at 8:18 pm | | Reply

      Great idea — but not if they parrot the ADA line (which most CDEs and physicians seem to do). In my opinion the ADA actually HARMS diabetics by encouraging them to eat high GI carb foods, which RAISE BGs.

    7. d2
      d2 October 11, 2007 at 8:28 pm | | Reply

      I am had too many discussions with diagnosed diabetics that make a choice NOT to take blood glucose readings with their meters. My Q? Does the Doctor check your history readings from your meter. NO. The article indicated that one has 5 – 7 minutes with a primary physician. Seven minutes is equal to 420 seconds. Five blood glucose readings for 90 days is equal to 450 BG readings in the meter history! At one BG reading per second, the doctor will not be able to view all of the readings in the meter!! What if the BG readings were uploaded into a diabetes management program? If the doctor does not look at the readings, why would the patient take the time to take the BG readings. The message is not getting out. Something needs to be done and 24/7 options can add to the educational opportunities.

    8. TomWoolworth
      TomWoolworth October 21, 2007 at 11:07 am | | Reply

      I like this idea … I have for some time voiced concern about MY health insurances provisions to have a Primary Care Physician or PCP. I have NO complaint with my PCP. He only spends 10-12 minutes with me. Does the minimum health checks. Asks I give blood, and will call me with the results. (inset cuss words here) Previous Dr. visits the PCP does NOT discuss the results with me … ( I have asked time and time again with no change) The PCP only writes my new scripts and sends me on my way (insert cuss words here).

      I now use a Diabetes Specialty Practice (ENDO and CDE). The insurance classifies them as a Specalists. The $25 co-pay it is well worth the 45 minutes to an hours of comprehensive medical review of Type 2 Diabetes.

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