PREFERENCES FOR CARESEEKING AT RETAIL CLINICS

Purpose: To assess the role of cost of care and appointment wait time in individuals’ decisions to seek care at retail clinics (walk-in clinics located in pharmacies, department stores and shopping malls).
Methods: We conducted a discrete choice experiment with 2 price levels ($59; $75), 2 levels of appointment wait time (same day; 1 day or more), 2 types of care setting-provider combinations (nurse practitioner at retail clinic; physician at private office), and 2 descriptions of acute illnesses (urinary tract infection; influenza) setting up 16 choice scenarios in a 2x2x2x2 factorial design. As part of a larger statewide random digit dial telephone survey adult residents of Georgia were asked if they would seek care under each of the 16 scenarios. There were 493 participants. We used conditional multinomial logistic regression to measure preferences for care at retail clinics and physician offices and the contribution of each attribute in the preferences. Willingness to pay (WTP) for change in each non-price attribute was calculated as the ratio between the coefficient for the attribute and the coefficient for cost of care.
Results: The positive and significant value of the constant term (5.629; 95% CI 4.560 to 6.698; p <.001) in the regression indicates that the respondents preferred to seek care for both conditions. Respondents were less likely to seek care for urinary tract infection than for influenza (β= -.149; 95% CI -.259 to -.038; p=.008), preferred to seek care at a physician office than a retail clinic (β= 1.067; 95% CI .923 to 1.212; p<.001), and preferred to receive care on the same day (β= -2.789; 95% CI -2.944 to -2.634; p<.001). There was no statistically significant association between the decision to seek care and age, race, gender, home ownership, marital status, education, income, or residence in metropolitan statistical area.
   WTP estimates suggest that cost saving of $31.38 would be required for the respondents to seek care at a retail clinic and cost saving of $82.03 would be required for them to choose to wait one day or more.
Conclusions: Given sufficient cost savings, changes in each attribute may also be acceptable to the respondents. Implications for access to primary care, future growth of these clinics, and the impact on physician practices require further studies of patients’ decision-making.