Article Figures & Data
Tables
Characteristic Houston Metro Medicare Population Retail Clinic Medicare Population Retail Clinic Visit, % OR‡ 95% CI Overall 366,225 4706 1.29 Age (years) <65 51,465 445 0.86 0.78 0.68 to 0.89 65–69 91,420 1196 1.31 1.00 70–74 80,721 1132 1.40 1.01 0.92 to 1.10 75–79 55,902 751 1.34 0.90 0.82 to 1.00 80–84 40,413 534 1.33 0.83 0.74 to 0.93 ≥85 46,934 648 1.40 0.84 0.75 to 0.93 Mean ± SD 71.89 ± 11.77 73.27 ± 10.24 Median (Q1, Q3) 72 (67, 79) 73 (68, 80) Sex Male 166,663 1804 1.08 1.00 Female 199,562 2902 1.45 1.29 1.21 to 1.38 Race/Ethnicity White 249,980 3795 1.52 1.74 1.55 to 1.95 Black 53,445 418 0.78 1.00 Hispanic 41,938 284 0.68 0.92 0.78 to 1.09 Other 20,862 209 1.00 1.15 0.95 to 1.40 Medicaid Eligibility* Yes 47,679 405 0.85 1.00 No 318,546 4301 1.35 1.26 1.12 to 1.43 Distance to nearest retail clinic ≤1 mile 164,806 2663 1.62 2.47 2.09 to 2.92 >1 to ≤5 miles 174,341 1876 1.08 1.81 1.53 to 2.14 >5 miles 27,075 167 0.62 1.00 Chronic conditions† 0 11,651 939 0.84 0.70 0.63 −0.77 1 47,152 639 1.36 1.00 2 50,063 691 1.38 1.01 0.90 to 1.12 3+ 114,128 1836 1.61 1.06 0.96 to 1.17 Hospitalization in 2014† 0 271,556 3159 1.16 1.00 1 34,292 608 1.77 1.22 1.11 to 1.34 2 9930 186 1.87 1.22 1.05 to 1.43 3+ 7216 152 2.11 1.41 1.19 to 1.68 Provider visit in 2014† Mean ± SD 7.75 ± 7.64 10.34 ± 8.93 1.02 1.02 to 1.03 Median (Q1, Q3) 6 (2, 11) 8 (4, 14) Having an identified primary care physician in 2014† Yes 163,972 2356 1.44 0.90 0.84 to 0.97 No 159,022 1749 1.10 1.00 ↵* To be eligible for Medicaid, individuals must meet financial criteria based on taxable income and tax filing relationships. For those aged 65 years and older, eligibility is determined using income methodologies of the supplemental security income (SSI) program. (Borella M, De Nardi M, French E. Who receives Medicaid in old age? Rules and reality. Fiscal Studies 2018;39:65–93).
↵† Beneficiaries with continuous enrollment of Part A and B without HMO in 2014.
↵‡ Results from multivariable logistic regression to examine patient characteristics associated with use of retail clinic (n = 322,994; those with Medicare Part A and B without HMO in 2014).
OR, odd ratio; CI, confidential interval; SD, standard deviation.
- Table 2.
Comparisons Between Patients With Retail Clinic Visits and Patients Without Retail Clinic Visits Matched by Propensity Score
Patients with an identified PCP in 2014 Patients without an identified PCP in 2014 Retail Clinic Retail Clinic No Yes† Standardized Difference (%) No Yes‡ Standardized Difference (%) N 7047 2349 5235 1745 Age, years <65 7.4% 8.0% 2.82 9.7% 10.2% 1.93 65–69 19.5% 19.5% 21.5% 21.3% 70–74 26.6% 26.0% 25.9% 26.0% 75–79 18.1% 18.6% 16.4% 16.4% 80–84 12.8% 12.7% 12.0% 11.9% ≥85 15.6% 15.2% 14.5% 14.3% Sex Male 34.9% 35.3% 2.02 42.4% 42.7% 1.72 Female 65.1% 64.7% 57.6% 57.3% Race/ethnicity White 82.3% 81.9% 1.57 82.0% 81.4% 1.94 Black 7.9% 8.2% 8.9% 9.0% Hispanic 6.3% 6.2% 5.3% 5.7% Other 3.5% 3.7% 3.8% 3.9% Medicaid eligibility Yes 7.2% 7.8% 2.42 9.3% 8.8% −1.79 No 92.8% 92.2% 90.7% 91.2% Distance to nearest retail clinic ≤1 mile 55.0% 54.4% 1.37 57.6% 57.4% 2.27 >1 to ≤5 miles 41.8% 42.3% 38.7% 38.4% >5 miles 3.2% 3.3% 3.7% 4.2% Chronic conditions (%) 0 12.1% 12.2% 0.86 37.6% 37.4% 0.51 1 15.4% 15.5% 15.7% 15.7% 2 18.8% 18.5% 14.7% 14.6% 3+ 53.7% 53.8% 32.0% 32.3% Hospitalization in 2014 0 74.3% 73.6% 4.89 82.9% 81.8% 5.54 1 17.3% 17.0% 11.7% 11.8% 2 5.1% 5.1% 3.4% 3.6% 3+ 3.3% 4.3% 2.0% 2.8% Provider visit in 2014 Mean ± SD 12.72 ± 8.28 12.97 ± 8.80 2.93 5.97 ± 5.84 6.23 ± 6.22 4.20 COC in 2014* Mean ± SD 0.82 ± 0.27 0.81 ± 0.28 −4.16 PCP visit in 2015* t test t test Mean ± SD 4.65 ± 3.84 5.00 ± 4.48 P = .0003 1.65 ± 2.37 2.26 ± 3.32 P < .0001 COC in 2015* Mean ± SD 0.80 ± 0.31 0.75 ± 0.33 P < .001 0.74 ± 0.37 0.64 ± 0.40 P < .0001 Saw the primary care physician in 2015* χ2 No 18.3% 21.4% P = .0012 Yes 81.7% 78.6% ↵* Variables were not included in the propensity model.
↵† Seven patients with an identified PCP and retail clinic visit were not within the overlap of propensity score; therefore they were excluded in matched cohort.
↵‡ Four patients without an identified PCP and having retail clinic visit were not within the overlap of propensity score; therefore they were excluded in matched cohort.
PCP, primary care physician; SD, standard deviation; COC, Continuity of Care Index.
- Table 3.
Comparisons Between Type of Retail Clinic Visit and Continuity of Care for Medicare Beneficiaries in 2015
Type of retail clinic visit in 2015* Proportion of Patients Who Saw PCP (%) P-Value Continuity of Care Index P-Value Chronic condition/preventive care 72.5 .012 0.68 ± 0.36 .0002 Simple acute condition 75.4 0.75 ± 0.34 Vaccination 83.1 0.80 ± 0.31 ↵* Single retail clinic visits for multiple complaints were assigned a single visit type designation, according to the highest ranking complaint, as designated by the following hierarchy (highest to lowest): chronic condition/preventive care, simple acute condition, and vaccination. Therefore, patients who received care for chronic conditions/preventive care may have also received care for simple acute conditions or for vaccination in one visit. However, patients who sought retail clinic care for vaccination received only vaccination at that visit, and no other type of care.
PCP, primary care physician.
