iKure Internship – Update 4

July 28, 2015 by

It’s been a busy July, and we were finally able to get the community health worker (CHW) training underway! Of course, since we are in the middle of monsoon season, the rains tend to get in everyone’s way. We were supposed to train 10 CHW, but 2 couldn’t make it on account of the rain. There is so much water, actually, that 5 of the women in our training told us we needed to be done before sunset since they need to cross a monsoon-made river by boat to return to their homes…very different.

The drive to Balichak (following one very….interesting….local train ride from Kolkata):

drive 1drive 2

After weeks of preparations and translations, it was great to be able to conduct the training. Our awesome translator knew exactly when to probe, how to ask questions and really helped the women feel at ease with us. It was a busy 5 hours, a lot of which was spent having the women experiment with the phones. For all of them, it was their first experience with technology beyond a T9-style keypad phone (which they only use to make calls), and so a comprehensive tech overview of how to use the smartphone took up a good chunk of our time.

CHW training


We also spent a large amount of time going over the clinical measurements and they all took the chance to practice with/on each other.

bp train practicing measuring blood pressure.

circumference train practicing measuring head circumference.

Finally, we spent the remainder of the time walking through each of the survey questions, really understanding what each one was asking, and then having them practice interviewing each other and me. Although Hindi is the national language of India, many of these women only know Bengali, and their English is basically memorizing relevant medical terms. They can also read English, but they don’t understand what it means. For example, we noticed that every time they saw the word “Date” (regardless of context), they always thought it meant “today’s date.” Every time they saw the word “Name,” they thought it was always going to be their names that they filled in.

The result of our busy day in Balichak was that the CHW are not proficient in English, and we are now in the process of converting all of our study material into Bengali. We are trying to make their jobs more fruitful, and making them learn/understand fancier English would only deter them from feeling successful in the field.

As my internship draws to a close, I will be working with the iKure team to construct a plan moving forward for how best to train these CHW and how to start our work. While it is unlikely that I will see the actual data come out of this study while I am still in country, it has been a wonderful experience to be a part of setting up the study and getting it off the ground.

The next update I post will be my last – hard to believe this summer is rapidly drawing to a close!

iKure Internship – Update 3

July 13, 2015 by

They always say that the time you spend at your internship will go by quickly….and those proverbial people were right! Time is flying so fast here…

Of course, it wouldn’t be a proper experience if everything we planned for actually went our way. We had backup plans and backups to the backups, but sometimes (no, all the time), reality rears its head and says “Infrastructure is important!”

In the last few weeks, I have been involved knee-deep in the ethics process of approving our research on the Indian side. It’s been a fascinating experience working with the committee and hearing their perspectives and opinions on healthcare. Now, we are waiting for final, official approval before data collection can start, which is very exciting!

In the meantime, I’ve been helping out fellow SPH HBHE student Anjuli with the another aspect of our project – technology! In my previous post, I mentioned we are using the ODK platform to collect data in the field. Anjuli is interesting in conducting usability tests to see how well the health workers like the platform, what suggestions they have to improve things and anything else they’d like to share with us. Which means more field visits for us!

Here she is conducting the first interview of the day!

Here she is conducting the first interview of the day!

road block

There wasn’t really a road that we took to the clinic….resulting in this scene becoming a common occurrence!

Last week, we had the opportunity to visit a town about an hour west of Kolkata, called Chengail. Deep off the road, pretty much within the forest, there is a multi-story clinic.

By the time we arrived, there were many patients in the “waiting room” – a little space built across the clinic entrance:

clinic waiting area

Clinic entrance sign!

Clinic entrance sign!

clinic 2

Outside view of the clinic

We went all the way upstairs to where the Community Health Workers (CHW) were going to meet us. We had planned to conduct the interviews such that while Anjuli interviewed one CHW, I would just chat with the others and find out who they are and why they really wanted to become trained as CHWs. My spoken Bengali is broken at best, but I can understand it quite well. My Hindi is pretty decent, but since these communities are more rural, most people only speak in Bengali….but our system of me speaking to them in Hindi and them responding in Bengali seemed to work out!

Always a great experience chatting with everyone!

Always a great experience chatting with everyone!

It was a really great experience being able to talk to them. They are all so excited about being CHWs because they come from backgrounds as housewives. They all said that they were happy to be serving their friends and neighbors in what they feel is a meaningful way. Anjuli conducted the interviews about the tablet and touchscreen phone technology, and it was great watching their reactions as many of them only use keypad phones for calling and sometimes texting. After a little bit of time with the tablets, they started to feel comfortable, showing each other how to move from screen to screen.

Overall, it was an informative day. These particular women had just started their training a week to the day before we arrived, and we had the chance to sit in on one of their classes – a lesson on anemia and the importance of iron and folic acid for pregnant women. It was fascinating to see how all of the material presented to them was in Bengali – one of the women said that the only English they know, they memorize the letters/words (i.e. they see the Bengali word for anemia, and then the English anemia next to it).

Pictures from the class session on anemia - this slide talks about the components of blood

Pictures from the class session on anemia – this slide talks about the components of blood

This slide mentions the different types of blood cells, with a histopathological diagram to go along

This slide mentions the different types of blood cells, with a histo-pathological diagram to go along

Here are some of the books that they use for their training

Here are some of the books that they use for their training           texts

The internship is an integral part of the MPH experience, and through mine so far, I’ve gotten to explore so many aspects of public health “in the flesh” – the opportunity to see our textbooks come to life is so important to building field skills, and I’m looking forward to our next two village visits to talk to more women and understand their roles in primary health care delivery.

Amazing group of women, and such a humbling opportunity to speak with them!

Amazing group of women, and such a humbling opportunity to speak with them!

iKure Internship – Update 2

June 22, 2015 by

And we’re off! Hard to believe the second week is coming to a close already…this week we focused more on the technology side of the project – getting the surveys and forms uploaded and ready for the Community Health Workers to use on the tablets!

This week I learned more about the technology aspect of our project. We are using a platform called ODK to digitize our surveys. Another U of M student helped to create these surveys and we have been playing around with it to understand the program and see how easy it is for the Community Health Workers to navigate. ODK has been really helpful to various projects around the world and I’m intrigued to see how it will work for our project. We still need to get the program on to all of the tablets so that we can use them out in the rural areas, but hopefully that will be done soon. We’ve done some preliminary playing around with it on one of the tablets, so that’s been helpful in shaping our game plan as we get ready to train.

A picture of the tablet that we are using: 20150618_094542_002

I also learned a lot about how research ethics works here in India. There’s an Indian Council of Medical Research (the ICMR) and all research projects need to have an Ethics Committee, which has to be formed by people of different professional backgrounds – lawyers, sociologists, clinicians, professors, laymen, etc. It was very neat to see the two aspects of informed consent in our research and how they differ but ultimately converge on a goal of ethical research practices.

The highlight of my week this week was the trip to the village of Godapiasal, outside of Salboni, which is about 3.5 hours away from Kolkata! It is always my favorite part to work directly with the people we want to work with and we want to help. After a rather uneventful journey in the early (but really sunny!) hours of the day, we reached the village around 9:30am and saw the building in which iKure clinics are conducted. The village is near the OCL Factory (a cement factory) and the community health workers and the government ASHA (Accredited Social Health Activist) workers serve the people in this area. We spoke with some of the workers on Thursday to get their opinions on how they felt about the surveys’ usability and ease on the tablets. They all really liked the idea of being able to use the tablets (there were many tales of lost notes due to rain), and we got to troubleshoot with them about how they felt about the survey questions.

We will eventually be conducting trainings on how they should administer the surveys to study subjects, but it was exciting to see and hear about how much they liked the platform for the research. It also gave us some important insight into some facets we can fix before officially training the CHW in the near future.

Pictures from our day trip to Godapiasal:

Selfie at the clinic :D20150618_100438

The iKure clinic welcome signs: 20150618_133725 20150618_095652

The iKure clinic surroundings: 20150618_09420820150618_094302

Troubleshooting the research surveys with 2 ASHA workers: IMG_20150619_202048

Anjuli, Jackie and Nick hard at work testing their own application with the ASHA workers: 20150618_123903

Overall it was a fantastic trip and I’m very excited for more visits out “to the field” as it’s been called! This week is a working Saturday week, so it was a long workweek, but definitely filled with fun adventures and lessons to make our work progress better…looking forward to the adventures that next week will bring!

iKure Internship – Week 1

June 12, 2015 by

aparnaIt’s hard to believe how a country that once just screamed sentiments of family, food and carefree fun can look so different after just a year at the School of Public Health. Immediately after getting off the plane, the humidity hits you (a punch to the hair) and the mosquitoes and cockroaches are everywhere. Getting in the cab, the familiar cacophony of obnoxious car and singsong truck horns, bicycles and motorcycles all weaving around seemed scary not funny like it once did. There was definitely some bliss in the ignorance that were my childhood India trips!

A picture of the traffic that greeted me so earnestly: 20150604_235842

The neatest thing I noticed this time, compared to the last time I had visited, were the public health bulletins all over the city of Kolkata – from prostate cancer, to general healthcare messages. It was heartening to see that preventive measures were starting to permeate the culture here…unfortunately I couldn’t capture a non blurry image of one…will look out for more.

I just finished the first week of my internship here at iKure in Kolkata. It’s a company with a really novel approach, synergizing technology and medicine for improved healthcare outcomes, and it’s been great seeing how they work! The first couple days we tried to iron out differences to get protocols and surveys ready for use. It’s cliche, but I really do take our American infrastructure for granted and never remember that until I’m elsewhere in the world. I’ll try to remember this the next time the internet wigs out for a second back in America; it’s nothing compared to the temperament of the internet here! It really dictates the speed at which we can accomplish any of our work. It seems like each day we got one step closer to our final goal: begin training the community health workers to collect data on maternal and child health outcomes (descriptive epidemiology) in rural West Bengal.

As the week drew to a close, I felt more and more pieces come together. I’m hoping that next week we will be able to get out into the field and get things going! It’s very hard to believe that an entire week has passed so far….I realize I haven’t been taking too many pictures – more to come for sure!

Obligatory cubicle selfie:20150606_113013

Some of my adventures at the gigantic mall I live right next to – discovered some oatmeal (if you look closely – they are masala flavored ;) )!20150611_195605

internship season

May 16, 2015 by

In the crazy wrap up of the semester, it’s been difficult to work on all of my online writing projects, but now that it’s summer I will have more time- in theory. Because  summer and for SPH students transitioning into second year, that means it’s internship season. We are all dispersed to new locations across Michigan, the United States and across the globe to see what public health looks like in action. It’s incredibly exciting and I cannot wait to see the wonderful work my classmates and colleagues will accomplish and learn this summer. It will be a summer of growth and challenge, that’s for certain.

My internship is with the University of Michigan’s MHealthy- a branch of their human resources department devoted to Health and Wellness of employees of the university. I am very excited to begin my work on projects and interventions, specifically in the Stress Management and Risk Reduction department. If there’s one thing I know as a student, it’s stress!

Some of my classmate-friends are headed out of the country! Check out Jhordan’s awesome blog documenting her summer in Chile. Another friend is already in Thailand, and a third is headed to India at the end of this month.

I will attempt to keep you all up to speed on my internship here on the SPH blog, but to also write about a few things that I learned in my last few weeks of second semester- like meeting a former Surgeon General of the U.S., potentially starting a new student org and UMMA’s student art night. I hope you’re all well, and happy summer! :)

Diptheria, Listeria….Hypsteria?!

April 1, 2015 by

aparnaIt’s hard to believe that my first year as a grad student is coming to an end!

Throughout the last few months, I have found so many reasons to rediscover my love for Ann Arbor, none of which include the ridiculous cold of course!

Compared to my experience as an undergrad student here, I’ve loved my grad experience a lot more. Any of you who are thinking about coming here from U of M – DO IT! It seems kind of crazy to think that anywhere on campus can be thought of as “small,” but that is exactly what SPH has been for me – a small, close knit community of friends, colleagues, faculty and staff that all work together for the betterment of the community.

I’ve enjoyed my experience in extracurricular activities here – most notably PHAST! You can read all about our experiences in Texas on the Frontlines Blog! It was great to see how a few months in the classroom could be turned into first hand knowledge a stone’s throw from Mexico.

IMG_3914 (It says PHAST 15 in the sand)

Another reason to love being a grad student here – everyone is so, so funny! Of course, as an epidemiology student, we’ve talked about all the main epidemic players – Ebola, Listeria, vaccine-preventable illness…but leave it to UMSPH to come out with breaking news on the latest epidemic – Hypsteria!

I’ll publish another post reflecting fully on my first year’s experience as well as preparations for my summer internship, but for now, watch the video to see why “Go Blue” is the only place you’ll ever need to go!

Speaking Plainly

March 31, 2015 by


I’ve found that when you’re passionate and knowledgeable, succinct writing is a challenge. Greater challenge still is when you are writing for a wider audience and you want those few words to be interesting and meaningful.  Writing in the Health Communication field certainly checks off all of these boxes in my mind, so I was happily anticipating my conversation with HBHE alum Holly Derry– who is a Behavioral Science Team Leader at the Center for Health Communications Research here at the University of Michigan- because I knew she’d be able to shed some light on the topic. I also wanted to know something of her background, because everyone here at U of M has a fascinating career journey.

 PK: What is your background- where did you obtain your MPH? Did you do a lot of Health Communication research during your time in school?
HD: I got my MPH from UM SPH in 1997 (I’m old!). I tried to take as many health comm classes as I could, but fewer were offered at that time, compared to now. Back then, the major focus of HBHE was more in the community organizing side of things, so I had fewer options. Still, Vic Strecher had just started, so it picked up eventually. Since then, I’ve audited some classes – Ken’s Health Comm class, Brian’s Sticky class, and Ken’s MI class.

PK: What drew you to the field of Health Communication research? What made you chose CHCR as a place of work?

HD: I was a psych major in undergrad and had always had my eye on clinical psych… until I did a semester-long stint at a crisis hotline calling center (with no training) and felt like I was in WAY over my head. Around that same time, I was taking a health psych class, and it really felt right. Then, I started to look into MPH programs (I didn’t even know they existed until then)… and got into UM. Once at UM, I met Vic Strecher at orientation (literally day 1!!), and he sold me on the principal behind CHCR: get all the people who develop health interventions  (designers, programmers, writers) under the same roof so they work together, speak the same language, and learn from each other. I was hooked. My second year of grad school (1996), I worked here at CHCR as a student… and then got a full-time job after I graduated.
 PK: Is there a specific population or topic you are particularly interested in?

HD: I’m fairly agnostic about the population and topic I work on – my general interest is tailoring the approach, technology, and (of course) messages to ANY topic and population. And frankly, this is what keeps my job interesting… for example:  thinking about designing an intervention for 65-year-old type 2 diabetics vs. 12-year-old girls in an after school exercise program.

PK: Do you have any tips/resources for me as an aspiring content/health comm writer about writing in plain language? [plain language: is communication your audience can understand the first time they read or hear it. read more about it here]

HD: I’m so excited you’re asking this question! It means you’re thinking about it – which is more than can be said for a LOT of others!!
1. It’s very difficult to switch from plain language writing (for lay people) and writing for your professors or funders. That said, *everyone appreciates plain language*… so writing plainly is ALWAYS a good thing. You’ll elaborate more and be less worried about multi-syllabic words in academic writing… but using the inverted pyramid and active voice are always always always good things.
2. I went to a health literacy workshop in Maine a few years back. It was helpful and had some good hands-on practice… it’s pricey, though, so you may want to wait to ask your first employer to send you to this or something like it.
3. Read “Letting go of the words.” Then read it again. Live it. Love it. Memorize it. Spread the word!!
4. If you need to target a certain reading level, I recommend using the SMOG test for reading level. It’s free and highly recommended by literacy experts. (Technically, experts recommend another one first – maybe Flesh-Kincaid? or Fog? can’t remember – but it’s expensive.) There are tons of websites where you can copy and paste your text and get a SMOG reading level. I use this one  Do NOT use Word’s built-in reading level calculator, if you can avoid it.
5. NCI offers this 1-hour online training, which isn’t bad. If you’re already fairly good, it may not be that helpful… but it’s only an hour (and it’s free)!
6. Please never ever ever call it “dumbing it down.” If you’re dumbing it down, you’re not doing it right. Plain language is about taking complicated ideas and wording and structuring them in a way that’s accessible to a wider audience. It’s partially about word choice… but it’s also about formatting it in a way that matches how people actually read.
7. Other resources (you probably already know about these):
8. If someone wants you to get down to 3rd grade reading level, be skeptical. In my experience, this request comes from either a) committees, or b) people who don’t really understand plain language and literacy issues, or c) both. If an audience’s reading level is concerning (low) enough, you probably shouldn’t be using written words at all. Instead, consider audio or video delivery. If people are literate… then an 8th grade level feels reasonable. Any less than that will alienate stronger readers and be stilted / awkward to read. Of course, this is an oversimplification and definitely represents a soap-box of mine… but there it is.

PK: How much has technology become a part of the health communications you create? Are the majority of your experimental interventions technology now?

HD: Technology is as integral as the words I write in our programs. I could write the best words in the world, but if they’re on a brochure in a grocery store lobby, no one will read them. If it’s on a device in their pocket… now we’re in business.
And yes, all of our interventions are tech-based. They have always been computer-based, because the tailoring we do starts from a computer-operated system. But back in the day, our tailoring system would generate print materials individualized for a particular person and then be mailed off. Now, we have a system that will deliver our tailored content in any way we can imagine – it will call people using IVR (interactive voice recognition), or deliver content to texts, websites, and mobile apps.

PK: Do you have a mentor or colleague in your professional life that has been influential?

HD: There are a LOT of people who have been influential in my career… At SPH, Ken Resnicow and Brian Zikmund-Fisher remain influential. Brian also works with Angie Fagerlin (at CBSSM –Center for Bioethics and Social Sciences in Medicine at the University of Michigan), and I’ve learned a ton from them and their research. Between these 3, they’re the ones I go to when I need advice or have questions.

PK: What are some trends you have noticed in the health communication field that would be important for me to be aware of/keep an eye as I go forward in my career?

HD: Mobile. Mobile. Mobile. We have to think about smaller devices (less real estate for the info we provide). We have to imagine that people aren’t reading our carefully-crafted paragraphs while comfortably seated in their quiet, private offices and giving us their undivided attention. They’re at a bus stop. They’re in a meeting. They’re at a red light. They’re having a conversation at the same time. They steal minutes (or seconds) to check something between (or while) doing other things… and so how do get our intervention to be the thing they check – to track what they eat, their exercise, whether they’ve taken their meds, etc. For that matter, how can we get the device to track things automatically so they don’t have to answer so many questions?
Related, how much information will people read at any one time? How do you craft an intervention that’s responsive to people’s reading styles? On the internet (as you’ll learn if you read “Letting go of the words,”) people skim and scan. This is why plain language is SO IMPORTANT. Use headings. Use the inverted pyramid. Step away from “walls of text.”
I think some answers to these questions include:
– use fewer words (say the right things, not all the things)
– find teachable moments (say the right things at the right time)
– infographics (say more with fewer words by using images)

Thanks very much to Ms. Derry for letting me interview her. I hope this helps anyone interested in Health Communications or any other potential writers out there- speaking plainly is not as hard as you may think! 

Economic development and health outcomes: The case of the Dominican Republic

March 24, 2015 by


The World Bank classifies the Dominican Republic (DR) as an upper-middle income economy with a $5,770 gross national income per capita (WB, 2015). The country is one of the top performers in terms of economic growth in Latin America. Paradoxically, after analyzing main social indicators one wonders why this economic development has not been translated into notable social progress over the years. In this blog I will focus on public health.

Aiming towards universal health coverage would contribute to reducing the incidence of catastrophic health expenditure. High health costs often have severe consequences in increasing poverty headcounts. In the DR there are important obstacles that prevent the country from reaching universal health coverage, such as very low government health expenditures and a big informal sector. Public health expenditure was 2.4% of GDP (WB, 2015) on average during 2000-2012, one of the lowest in Latin America.

Despite some achievements in health outcomes over the last decade, basic public health indicators such as infant mortality rate remain way above the Latin American average and worse than countries with similar levels of economic development like Costa Rica. In 2013, it stood at 23.6 per 1,000 live births, as compared to 8.4 per 1,000 live births in Costa Rica (WB, 2015).

Meeting the goals of the 2001 health reform and achieving universal health coverage is not an impossible task. For example, Thailand has had a universal health coverage scheme since 2002, when it had similar levels of public health spending as DR has today. It is a matter of designing the correct payment incentives based on performance indicators to improve quality in the system. Also, reforms should be piloted focusing on the most vulnerable populations that are affiliated to the national health insurance, SENASA. Currently, 29% of the population is affiliated through the subsidized regime (SISALRIL, 2015), but its expansion has been low given that it relies directly on budgetary appropriations. There is a significant opportunity for improvement if the mixed subsidized-contributive regime is fully developed, which allows for more poor people to be targeted into the subsidized regime.

The Dominican Republic is an amazing country with very favorable economic prospects. It is time to revisit the organization of the public health system and contribute to build a bridge between the status of upper-middle income country and its social indicators.

Being a graduate student instructor (GSI) v. graduate student research assistant (GSRA)

March 1, 2015 by

amy I have been fortunate enough to experience being both a graduate student instructor (GSI) and graduate student research assistant (GSRA) for the biostatistics department within my two years here. I was a GSI my first three semesters, and am currently a GSRA this last semester. While I think many graduate students incoming to UM, reputed as a large public research institution, are rearing to partner with faculty and partake in discovery, I see distinct pros and cons to both positions:

Pros and cons of being a GSI:


UM’s Center for Research on Learning and Teaching offers GSI resources

Pro:  Meeting new people. As a GSI my first semester–a time when everyone is a stranger!–I became close to four of my biostatistics classmates through long homework grading sessions, helping one another field questions during office hours, and managing class policy and administrative issues; moreover, I instantly met at least 70 fellow public health students from other, diverse departments within the School of Public Health (SPH), students with whom I would’ve never crossed paths if I were not their instructor. Because I met all these colleagues of mine on day 1, since then I’ve been able to smile, stop, and chat in the hallways when I frequently see a familiar face. It has made SPH a much more friendly place.

Pro: A fixed schedule. GSI-ing, as opposed to GSRA-ing, is a much more organized job affair in that there are dedicated times for your teaching responsibilities and you will rarely spend more hours than expected attending to them. Aside from the occasional request to meet outside of class for an extra tutoring session or overly in-depth homework question in email form (difficult to answer when that question is quantitative), GSI-ing doesn’t tend to spill outside the boundaries of your two laboratory sections, 2-3 office hours, and grading sessions.

Con: Student conduct issues. It is uncomfortable to encounter multiple assignments that are suspiciously identical, or seemingly copied from the solution manual. One might think that there is some satisfaction to catching cheating incidents, but I don’t think any teacher relishes the experience. No one likes to stir up drama surrounding academic dishonesty when the vast majority of students are attending class and diligently attempting assignments, struggling or not.

Pros and cons of being a GSRA:


Pro: Learning and applying new methodology. Research has allowed me to move past the theory of statistical methods emphasized in coursework to actually applying these analyses to real-life clinical investigations run by epidemiologists, professors, and physicians in SPH, the UM Health System, and health centers across the nation. It’s eye-opening interacting closely with one or two faculty members on a professional as opposed to instructive level, seeing how they approach problems and gaining insight into harsh work-life balance of academia.

Pro: A flexible schedule. Just as how GSI-ing is nice in that one’s schedule is very strict, GSRA-ing is nice for the very opposite reason in that one’s schedule is quite flexible. If you have a slew of midterms coming up, it’s okay to delay some research tasks for a few days and catch up later, while abandoning one’s section as a GSI is clearly not an option. GSRA-ing involves more time-management skills, but accordingly more leeway in when and where you do your work.

Con: More hours. I can only speak for my own experience, but GSRA-ing has required many more hours per week than GSI-ing. It’s easy to get absorbed in a coding problem, or sit for hours muddling through a “dirty” dataset. While research work is open-ended and thus intriguing, it leaves less time to complete the traditional but mandatory homework assignments and studying for courses.

Retail Clinics and population health

February 20, 2015 by


Retail clinics (RCs) initiated as a response of the market to unmet needs of healthcare consumers for accessible, convenient, and cost-effective basic health services. As the clinics become a popular means of treating minor medical conditions at lower costs, they have established a niche in the health care system based on their convenience and accessibility for both insured and uninsured patients. Retail clinics are typically located in store chains that patients already visit on a regular basis, such as CVS, Walgreens and Wal-Mart.


The clinics can operate under three different business models: 1) the clinic is owned and operated by the parent store that houses it; 2) an independent company owns the clinic and partners with a retail store to house it; and 3) an integrated model where the clinic is owned by a hospital, a physician group, or another health care provider. Nearly three-quarters of clinics follow the first model (RAND, 2010).

The rapid expansion of RCs is attributed to costumers’ favorable response to the model. Convenient hours and locations are major factors in choosing the clinics. RCs generally employ a nurse practitioner or a physician assistant with off-site supervision by physician medical directors, providing services at accessible locations, shorter wait times, and lower costs.


Despite being a relatively new phenomenon, these clinics have the potential to increase access to basic health services to the underserved population. RCs have the necessary infrastructure –capacity for 17 million visits a year (Bureau of National Affairs, 2009)– to alleviate the shortage of primary care physicians that is intensified by the increase in demand for health services as a result of the 11.4 million newly insured under the Affordable Care Act. However, retail clinics have faced financial barriers to establishing contractual relationships with Medicaid. Also, they have to deal with state-level regulatory constraints including scope of practice laws and prohibitions against the corporate practice of medicine. These restrictions tend to limit the clinics’ ability to operate in medically underserved areas (Bartlett, 2011).

Massachusetts became the first state that adjusted its regulatory framework to fit RCs into their health system, by enacting in 2008 new regulations that specify the medical conditions and age groups that may be treated at the clinics. This proactive approach to design a tailored regulation for the operation of RCs is a good example for other states to consider how to better integrate RCs with traditional models of care. States Departments of Health play an important role in the development of this model, which has the potential to improve population health outcomes and decrease healthcare costs.


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