Nurses to staff clinics in some CVS pharmacies, with D-H doctors’ oversight

Dec. 04--In the latest expansion of the health care industry, CVS pharmacies in New Hampshire will be opening clinics staffed by nurse practitioners, with Dartmouth- Hitchcock physicians as medical directors.

New Hampshire is the 28th state where CVS has opened what it calls MinuteClinics inside its pharmacies. These can be considered one step below immediate care facilities, designed to handle straightforward problems like colds or poison ivy, help monitor chronic ailments, and guide people toward more care if necessary.

Staffed by a nurse practitioner, they do not have X-ray machines but can perform certain lab tests, such as those for mononucleosis or strep throat.

"This is another layer of access for patients that is coordinated with their primary provider ... or to help them have access to a doctor, if they don't have one," said Dr. Ethan Berke, director of population health innovation for Dartmouth-Hitchcock in Lebanon.

That last point is important. "Nationally, about half of our patients don't have a doctor," said Anne Pohnert, a nurse practitioner who is Northeast area director for MinuteClinic.

She said the clinics will direct patients with doctors to any local providers, not just those affiliated with Dartmouth-Hitchcock. They can send prescriptions to any pharmacy, not just CVS, she said.

"They might say, 'We are worried about your blood pressure, even though you came for your cold -- here's a list of providers in the area,'?" Berke said.

MinuteClinics opened this week in Concord and West Lebanon. A Salem clinic will open Dec. 11, and the Nashua clinic, in the CVS at 214 Daniel Webster Highway, is scheduled to open in early January. Clinics also are slated to open at that time in Hampton and Manchester.

The clinics are a continuation of a trend over the past few decades to move some health care services out of hospitals and emergency rooms and into smaller, more accessible facilities. The hope is that the clinics will cut costs and expand access.

Such facilities have fewer staff members and less equipment than emergency rooms, and often have shorter hours, but are much less expensive.

Southern New Hampshire Medical Center's half-dozen Immediate Care sites are examples, as is the decision by St. Joseph Hospital to change its free-standing emergency room in Milford to an urgent care facility.

Pohnert said average MinuteClinic visits cost $79-$89 and are covered by many insurance plans -- including Anthem Blue Cross, the only program under the Affordable Care Act in New Hampshire next year. They also are covered by many national Medicare programs, she said.

MinuteClinics started in Minnesota and are now a division of CVS. The program has seen more than 17 million patients since it opened in 2000.

"We were started by a dad who had kids with sore throats. He spent one too many weekends in the ER, waiting hours for a strep test," Pohnert said.

Having medical direction from a major clinic is typical for MinuteClinics around the country, she said. Dartmouth-Hitchcock will provide two physicians, a portion of whose salary will be paid by CVS, Berke said.

They will act as medical directors for all the MinuteClinics in the state, checking a percentage of patient charts, overseeing clinical quality, doing monthly continuing-education conferences, and being available on call.

"Occasionally, we have somebody who's in a gray area, right on the edge, maybe is sicker that we want to them to be, and the (nurse practitioner) will want to discuss it," Pohnert said.

Nurse practitioners are a level of nursing up from RNs who usually have advanced degrees rather than just bachelor's degrees. They can diagnose and treat many illnesses and can write prescriptions.

MinuteClinic and Dartmouth-Hitchcock said they will work to integrate electronic medical records, an improvement from the traditional model of faxing patient records between health care providers.

With patient consent, MinuteClinic said it would share medical histories and visit summaries electronically with other Dartmouth-Hitchcock locations in New Hampshire, and send patient visit summaries to primary care providers by fax or mail, typically within 24 hours.

MinuteClinic is accredited by The Joint Commission, the accrediting body for hospitals and health care organizations in the U.S.

MinuteClinic said its nurse practitioners specialize in family health care. Aside from handling minor illnesses, they can treat minor wounds, abrasions, skin conditions and joint sprains; give common vaccinations such as influenza, tetanus, pneumonia, pertussis and hepatitis A and B; and give physicals required by many camps, colleges and organizations. They also offer screenings and monitoring for diabetes, high blood pressure and high cholesterol.

The clinics are generally open 10 hours Monday- Friday, eight hours Saturdays and seven hours Sundays, Pohnert said.

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David Brooks can be reached at 594-6531 or dbrooks@nashua telegraph.com. Also, follow Brooks on Twitter (@GraniteGeek).

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