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VOL. 7 | NO. 40 | Saturday, September 27, 2014

More Stores, Walk-In Clinics Offering Vaccines and Shots

By Don Wade

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Pull up to a local Walgreens and you may be immediately presented with a shot menu: flu, shingles, pneumonia and other options. Theoretically, in one trip to the drugstore you can knock out your flu shot, pick up some ice cream, bread or beer, maybe grab a birthday card for your mother-in-law, and be on your way.

“Those injections all used to be done in primary care offices,” said Dr. Guy Reed, chair of the department of medicine at the University of Tennessee Health Science Center. “People are going to move toward convenience.”

And convenience is big business. A recent Associated Press story described the number of flu shots Walgreens provided last flu season as “enough to protect a population roughly twice the size of Los Angeles.” CVS, the report said, gave more than 5 million flu shots – or more than double the business it did just a few years ago.

Technician Randy Humphrey fills syringes at Atlas Men's Health where patients can come in for shots of various kinds.

(Memphis News/Andrew J. Breig)

“The whole premise of our business is to make it available and convenient,” said Deborah Overall, a nurse and the administrator at The Shot Nurse, which has three Memphis-area locations. “You’re not going to take off work to go to the doctor to get a flu shot.”

You also might not want to take off work on a Monday after a Sunday of too much revelry while watching football. Atlas Men’s Health, a clinic in Midtown open for about a year, offers IV Hangover Therapy, testosterone therapy – which they advertise frequently on local sports talk radio – and an array of routine vaccinations as well.

“You can run in here and be out of here in 10 or 15 minutes,” said Atlas Men’s founder Robert Booth. “Which people really can’t do with their primary care doctor.”

Eleven local Walgreens have nurse practitioners that are monitored by Baptist, said Jim Boswell, vice president of physician services for Baptist Memorial Health Care and CEO of Baptist Medical Group.

Michael Ugwueke, president and chief operating officer of Methodist Le Bonheur Healthcare, said they have not gotten into the clinic/shot business yet but “we looked at it. We felt patients need a medical home. There’s nothing wrong with these entities, but if you want to manage somebody’s health, they have to have a place to call home. That’s why we’re not currently in it. Not to say we’re ruling it out.”

Baptist’s new electronic record-keeping system will help with the tracking of patients seen at the nurse practitioner clinics in Walgreens. But Reed, of UTHSC, and others have broader concerns about the trend of patients going to outposts, if you will, for immunizations.

Certainly, its appeal to the companies selling the shots is understandable.

“The vaccine is, I think … a good marketing tool to bring people in,” Eric Keuffel, a Temple University health economist, told The Associated Press.

“What we’re seeing now with the Affordable Care Act is a period of creative destruction in terms of old health care models,” Reed said. “Walgreens and other companies are moving into primary care.”

Dr. David Jennings of the Church Health Center has used The Shot Nurse to get a shingles shot and a travel vaccine.

“They provide a valuable service in that regard,” he said. “A flu shot, from a public health perspective, the more people we get vaccinated the better.”

Reed says immunizations were, traditionally, one of the ways physician practices supported themselves. “If all that takes place elsewhere,” Reed said, “it makes primary care less sustainable.”

In 1999, fewer than half of states permitted pharmacists to administer flu shots. Now, all 50 states allow it. Thus, it’s no surprise that about half of all flu vaccines provided to adults are administered in nonmedical settings such as a drugstore or shot clinic.

The full menu at The Shot Nurse ranges from $25 for flu and lipo shots to $65 for TDaP (tetanus, diphtheria and pertussis) to $165 for a Gardasil vaccine to $225 for a shingles shot. Overall mentions the Gardasil vaccine as one that’s very important, and underused, for teenagers and young adults in protection against a potentially cancer-causing sexually transmitted virus.

“Totally preventable,” she said.

The Shot Nurse also is in the testosterone therapy business, developed under the supervision of a urologist, Overall said.

“There are patients that can benefit” if bloodwork shows their testosterone is low, Jennings said.

“But self-referring to clinics, I have concerns. The safety of testosterone is being debated at the national level by experts,” Jennings said, adding that possible side effects may include risk of developing diabetes, heart disease or prostate cancer.

What seems certain is the demand for convenient vaccination services isn’t going away. The Centers for Disease Control provides detailed immunization information at its website – www.cdc.gov/vaccines.

“There will always be a need for vaccines,” Overall said.

And there will always be people who would rather not get them, no matter where they’re offered.

“They’re really scared of needles,” Overall said. “You see a lot of men that don’t like them, and teenagers, too.”

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