Sick after hours? How to navigate your health care options

This story is the latest in a series on how to better navigate the health care system.

So you’re coming down with some sort of bug, and it’s Saturday afternoon – when your doctor’s office is closed.

If you want some medical help but don’t need a trip to the emergency room, there are options aplenty: You could try that urgent care center down the road. There’s the clinic in the back of the drug store. You could try one of the new online services that let you videoconference a doctor.

But what will you get from each of them? How do you decide where to go? And what does the proliferation of “convenience care” facilities mean for health care?

“The urgent care capacity in Connecticut has kind of exploded,” said Dr. Peter Bowers, medical director at Anthem Blue Cross and Blue Shield.

Proponents say that means patients now have more options for care at any time. That can help them avoid going to the emergency room for non-emergencies – and get care with less wait and at lower cost.

But some say there are tradeoffs. Some physician groups have raised concerns that the use of convenience care facilities leads to more fragmented care. Others have noted that the facilities are more likely to be built in higher-income areas, rather than places where more people already struggle to access care.

And even with multiple options available, it can still be challenging for patients to figure out which is best for their particular symptoms, noted the authors of a 2015 report on retail clinics and urgent care centers in New York.

“Patients must navigate this rapidly changing world of ambulatory care services with limited information, at a time when symptoms and concerns about their health are already creating stress,” they wrote.

Here’s a look at the options and advice from experts on how to handle non-emergency after-hours medical needs.

Know what’s what

For starters, it helps to know the difference between the various options.

In Connecticut, there’s no formal definition of what an urgent care facility or retail clinic is; they’re all licensed as outpatient medical facilities. (That could change; Gov. Dannel P. Malloy’s administration has proposed creating a separate license for urgent care facilities.)

But experts and trade associations generally refer to them based on certain distinctions.

Retail clinics are generally located in other facilities; think CVS’ MinuteClinics or Walgreens’ healthcare clinics. They’re often staffed by nurse practitioners, and tend to offer a set list of services, including flu shots, testing for strep throat or other minor illnesses, or treatment of minor injuries.

Urgent care centers typically provide a broader range of services; many offer imaging services such as X-rays in addition to routine primary care. They’re often staffed by doctors or nurse practitioners. The ownership models vary; some are owned by hospitals or health systems, while some are owned by doctors or separate companies. Some hospitals now partner with urgent care centers; the Yale New Haven Health System recently announced a partnership with PhysicianOne Urgent Care, while HartfordHealthcare is opening facilities with the company GoHealth Urgent Care.

There’s also telemedicine, in which patients communicate with a health care provider by live video, usually on a smartphone or tablet. Some health care providers offer virtual visits to their existing patients. There are also services that provide telemedicine by connecting patients with doctors licensed in their state.

Be prepared: Ask your regular doctor what to do – before it happens

If you’re already sick after hours, this won’t help you, but use it for the future: Experts say the best thing to do is to ask your regular doctor what you should do in case you need care after hours or on a weekend. Ask before you need it.

Some medical practices have partnerships with certain urgent care facilities or other types of after-hours arrangements, which would make it easier for your records to be shared. You might even find out your doctor’s office has someone available to see you after hours. There’s been a push in recent years for primary care providers to improve after-hours access, and some now offer virtual visits through telemedicine, said Dr. Ann O’Malley, a physician and senior fellow at Mathematica Policy Research, which has studied after-hours care.

“That’s really the first place to go, if it’s not a true emergency, is your own doctor,” she said. “Because they know you best. They have access to your medical records. They just have so much more information about you than a stranger would in another type of setting.”

“Continuity of care is very important,” she added. “Not only is it valued by patients and doctors, but it’s associated with much better quality of care and improved outcomes.”

Even if you haven’t done that prep work and you’re sick now, it’s worth a call to your primary care provider’s office, experts say.

“Most primary care providers have a live provider that will talk to you through it and help you navigate that,” Bowers said.

Get documentation of what happened or have it sent to your primary care provider

If you’ve gone to an urgent care center or retail clinic, or done a virtual visit using telemedicine, experts say you should be sure to get a record of what happened so you can give it to your regular medical provider, or have a copy sent to your doctor.

“I do recommend that, empowering people to get documentation of what went on and why. That’s a good thing, because I think our system still is pretty fragmented,” Bowers said.

It’s a good practice even for something that seems minor, O’Malley said.

“There are lots of things that may seem fairly simple…that could be signs of larger problems,” or another condition, she said. “It’s very important to close the loop as a patient if those practices or different entities don’t already communicate with one another or share records.”

O’Malley recommends keeping your primary care provider’s card in your wallet, so you can give his or her contact information to any other medical provider you see.

“It’s very important to close the loop as a patient if those practices or different entities don’t already communicate with one another or share records,” she said.