Texas Children’s provides pediatric patients appropriate, comprehensive primary care at more than 50 pediatric primary care practices throughout the city and several urgent care locations.
By Stanley Spinner, MD
Retail based after-hours care: a poor choice for treating children
In the past, if we were sick and sought medical care, we would see our family doctor during routine office hours or, if it was urgent, go to an emergency room. But over time, our expectations have changed. We now expect convenient care at convenient times.
The United States has seen an explosion of adult-based urgent care and emergency care centers in recent years, with many located inside pharmacies and grocery stores. Nearly 30 percent of the U.S. population lives within a 10-minute drive of a retail clinic, and the Greater Houston area is no exception.
Most after-hours clinics are staffed by non-pediatric mid-level providers, with a few offering care from non-pediatric physicians. From the standpoint of a children’s health care provider, this is precisely the problem. As pediatric care specialists, we frequently need to reiterate that children are not simply “little adults,” and the care they receive at these clinics is often less than optimal. I have shared the same experiences with many of my pediatrician colleagues as we continue to see patients returning to our offices following visits to these clinics.
Typically, parents are questioning the care their children received at the clinics, and in many cases, their concerns are well-founded. We often see children who have been diagnosed improperly, have been given inappropriate medications or medications at the wrong dose, and have undergone unnecessary lab testing or imaging.
In 2014, the American Academy of Pediatrics issued a policy statement advising pediatricians to discourage the use of retail-based urgent care clinics for their pediatric patients, citing the delivery of less-than-optimal care and the loss of continuity of care.
This recommendation presents a quandary for the pediatric community. Simply advising our families not to seek care at one of these clinics is unreasonable. We know that more and more of our families will continue to seek after-hours urgent care. But we also know that making ourselves available throughout the community will go a long way toward preventing families from getting sub-par pediatric care.
Our Texas Children’s Pediatrics network comprises 52 practices spread throughout the Greater Houston area. Several of our practices provide after-hours care for established patients. In addition to these, several more of our practices offer acute care visit appointments into the early evening hours, and many of our practices offer Saturday morning hours.
Despite our efforts, the greater pediatric community has not been afforded this type of quality pediatric after-hours care. We have much work to do, and I am delighted that we’ve now opened Texas Children’s Urgent Care clinics. Our goal is to expand this network of pediatric after-hours urgent care clinics throughout the Greater Houston area, so that we will be able to better meet the demands of our families.
What is the difference between after-hours urgent care and an emergency room or emergency center?
An after-hours urgent care facility typically handles mild to moderate acuity problems, much the same as would be seen in a physician’s office during the day. Most of these clinics are not open 24 hours. Forty percent of Texas Children’s Hospital Emergency Center visits could be handled in an urgent care clinic rather than in a true emergency room.
An emergency room or emergency center is capable of handling most major emergencies and is typically open 24 hours a day. Another major difference is cost. A typical emergency center visit can cost up to four times as much as an urgent care visit. This increased cost is shared by both the payer and the patient.
If my child has a simple complaint, such as ear pain or a sore throat, how much could the care he or she receives at a non-pediatric clinic differ from a pediatric-based clinic?
We frequently see children who have been given antibiotics when they clearly had the types of infections for which antibiotics are not effective (viral infections, not bacterial infections). Additionally, the medications prescribed by these non-pediatric practitioners may not be appropriate for a child’s needs and are often written for the wrong doses.
Unfortunately, many of the adult-based after-hours clinics do not send any information back to the child’s primary care physician, creating significant gaps in the continuity of care.
Besides Texas Children’s Urgent Care and Texas Children’s Pediatrics, are there any other pediatric after-hours urgent care clinics in the Houston area?
Yes. There are a handful of pediatric after-hours clinics in the Houston area that are not affiliated with either Texas Children’s Pediatrics or Texas Children’s Urgent Care. Those providers are not credentialed by Texas Children’s, nor do they have access to children’s medical records from Texas Children’s Hospital.
On the flip side, any Texas Children’s Pediatrics practice or Texas Children’s Urgent Care provider has access to the medical information of any child who has been treated within the Texas Children’s system. In addition, all of our providers are credentialed through Texas Children’s Hospital and offer consistent care based on standards established by the American Academy of Pediatrics.
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