An Analysis of Testimony for Retail Clinic Regulations in MA: Implications for Teaching NP Students the Policymaking Process

 

Research Objective:
To conduct a content analysis of all public testimony regarding proposed MA Department of Public Health limited service (aka retail) clinic regulations in 2008 to meet the following 3 objectives: 1) identify common stakeholder themes 2) assess the impact of testimony on changes made to final regulations 3) report implications for teaching NP students about policy

Study Design:
A comprehensive literature review identified themes that support or reject the retail clinic model. Using these themes as a starting point, two NP student research assistants conducted independent content analysis of 45 public testimonies provided to the Massachusetts Public Health Council regarding draft retail clinic regulations issued in fall 2008. Findings were compared and reconciled. Content was grouped into themes and interest groups with common views were identified. Findings were then compared to changes in the final regulations.

Principal Findings:
Themes of testimony mirrored those found in the literature. Consumer convenience and cost were major themes in support of retail clinics. Fragmentation of care and sub-standard quality were representative themes urging disapproval. Advanced practice nursing and industry were affinity groups in support of these regulations. A number of other health care providers including hospital, physician, and community health centers groups opposed adoption of these regulations. Consumer input was negligible on both sides. Public health department changes in the final regulations reflected responses to safety, fragmentation of care concerns, limiting the scope of practice for providers in these limited clinic settings.

Conclusions:
Affinity groups were predictable. Nurse practitioner groups did not garner support of other health care providers. Arguments for safety and fragmentation of care were addressed in changes in the final regulations.

The use of nurse practitioners to staff retail clinic settings has possibilities to expand access to care and reinforce the “autonomous” role. This research reinforces the need to teach NP students to be active participants in the policy making process including the regulatory phase as well develop skill sets related to coalition building.