Y. Bar-Yam, D. Harmon, K. Nesbitt, M. Lim, S. Smith, B.A. Perkins, Opportunities in Delivery of Preventive Services in Retail Settings, Handbook of Systems and Complexity in Health (Springer, 2013): 879-887.
In the US, recommended clinical preventive services are not being delivered despite well-documented benefits. Here we show that transferring simple and repetitive preventive services to nurse-staffed retail clinics provides an opportunity for dramatically improving their delivery. For each of 35 high-benefit, cost-effective preventive services, we identify required training, number of repetitions, and time and cost for full coverage in the US. We determine that full delivery through physician-based practices would require an unrealistic 400,000 full-time personnel. We estimate the efficiency gains from implementation at nurse-staffed clinics at retail locations for 28 services. Widespread adoption would result in a five-fold reduction in variable costs and three-fold reduction in personnel. By elevating the benefit-to-cost ratio, retail implementation can expedite widespread prevention coverage and help transform US healthcare.
Figure 2. Personnel requirements for fully delivering clinical preventive services in the current healthcare provider setting