May 2019 Volume LIV Number 3

 
 
 
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Litch’s Law Log: Consumer Convenience Versus Quality Care?

May 2014 Volume L Number 3

The American Academy of Pediatric Dentistry recommends establishment of a Dental Home for all children by age 11. This is also supported by the American Dental Association and the American Academy of Pediatrics (AAP), and the concept is modeled after the medical home recommendation of the AAP. However, given changes in health care delivery spurred by the Affordable Care Act (ACA) and other factors, the concept of establishing an ongoing source of regular 
health care with an actual doctor is jeopardized. We are all familiar with the dental therapist crusade in dentistry, but stepping back to look at medicine (which also features a hot debate over mid-level providers) we see an interesting consumer convenience trend that also challenges the medical home model. 
 
This prompted an update of AAP policy and a press release on Feb. 24, 2014, indicating that the AAP Advises Parents Against Using Retail-Based Clinics. Their statement is that: 
"Families may decide to use a retail-based health clinic because they believe it is convenient and less expensive, but according to the American Academy of Pediatrics, these clinics do not provide children with the high-quality, regular preventive health care children need." 
 
The updated policy statement published in the March 2014 issue of Pediatrics, says that: "retail-based clinics are an inappropriate source of primary care for children because they fragment children's health care and do not support the medical home." 
 
However, such clinics have increased since the original 2006 AAP policy statement, now numbering 6,000 as of 2012, with surveys indicating that 15 percent of children are likely to use a retail-based clinic in the future even though the majority of patients utilizing such clinics are adults. 
 
AAPD past president and CDBP Chair Dr. Paul Reggiardo has called such trends the "commodization" of health care. If a medical or dental care provider is of exactly the same quality from location to location then what difference does it make where the care is delivered so long as a doctor is involved somewhere in the process? With the 
electronic health record, perhaps your care can be coordinated even while driving around the county or state from retail clinic to retail clinic. 
 
But of course, quality is not the same everywhere. Health profes- sions are a competitive, but highly regulated occupation. Licensing is required to practice, as a public safety measure versus anyone being able to hang up a doctor sign. Chances are that the doctor (if there is one) working at a retail health clinic is not an experienced pediatrician who has a thorough understanding of your child's medical history. 
 
Clearly the retail clinic approach in medicine is driven by conve- nience. Perhaps dentistry is far ahead of medicine in understanding this factor. Many dental offices are conveniently located near homes, schools, and shopping centers as opposed to requiring a parent to travel to a major medical center in a far-off city or town. However, with a societal expectation of 24/7 access to care (at the same time that payers are trying to keep patients from making unnecessary ER visits), it does force the practicing pediatric dentist or pediatrician to reconsider clinic hours. How do their offices accommodate two working parents or a single parent who might find it difficult to bring a 
child in for a medical or dental visit between 9 a.m. and 5 p.m.? 
 
Consumer education and health literacy are also factors. In a recent AAPD-commissioned survey, only nine percent of parents had knowledge of the concept of a Dental Home—an ongoing relationship with a primary dental care provider 
and patient in which oral health care is delivered in a comprehensive, continuously accessible and family-centered 
manner. Once given an understanding, 89 percent stated that they are likely to take their child to a pediatric dentist.2 
 
AAP makes a strong point that parents should expect their child's doctor to have unique training in child health, and should understand that "even a simple complaint may be related to a more serious, underlying condition that could be overlooked by someone who is less familiar with the patient . . ." AAP recommends that parents only consider using retail-based clinics for acute needs and only at those clinics having a formal relationship with their child's pediatrician. This advocacy is essentially for one standard of care for all children. Some seeking to save costs and expand access suggest that non-doctor "triaging" can take place. But ultimately, the strongest rationale for a medi- 
cal or dental home is that a child can receive a definitive diagnosis and preventive or treatment plan (if necessary) from a well-qualified doctor, not guesswork. 
 
For further information contact Chief Operating Officer and General Counsel C. Scott Litch at (312) 337-2169, ext. 29, or slitch@aapd.org. 
 
 
 
1See: http://aapd-oldsite.ae-admin.com/media/Policies_Guidelines/P_DentalHome.pdf 
 
2Per AAPD's Monster-Free Mouths campaign: http://aapd-oldsite.ae-admin.com/america%E2%80%99s_pediatric_dentists_bite_into_problem_of_rampant_tooth_decay_in_little_teeth_and_encour- 
age_parents_to_join_the_monster-free_mouths_movement/ 
 

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