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San Francisco Marin Medical Society Blog

After Hours Medical Clinic Fills Void in San Francisco

Americans work longer hours than workers in most other developed countries. The typical American middle-income family put in an average of 11 more hours a week in 2006 than it did in 1979. Although more than 805,000 people reside in San Francisco, there were no after-hours clinics available to accommodate busy families until the establishment of the After Hours Medical Clinic in March 2012.

Staffed by the Pacific Family Practice Medical Group, the clinic provides much-needed non-office, after-hours medical care at reduced cost for both patients and insurers. The clinic operates from 5:00 pm to 9:00 pm on weekdays and from 10:00 am to 4:00 pm on Saturdays.

An after-hours clinic provides walk-in care that focuses on acute conditions and exacerbations of chronic conditions. In a study done by the California HealthCare Foundation, the most common diagnoses seen in non-emergent and non-primary care settings are upper respiratory infections (60.6 percent); preventive care, such as vaccinations and preventive exams (21.6 percent); other minor conditions such as allergies, insect bites, rashes, and conjunctivitis (9.5 percent); and urinary tract infections (3.7 percent). These four groups of diagnoses accounted for more than 95 percent of all visits to acute care clinic sites.

According to “Health Matters in San Francisco” and the California Office of Statewide Health Planning and Development, 18,000 emergency department visits were preventable. Dr. Robin Weinick of RAND Health, one of the largest private health research groups in the world, estimates that 13.7 to 27.1 percent of all emergency room (ER) visits could occur in less intensive, walk-in-based care facilities. A combination of increased working hours for patients and diminished primary care access result in unnecessary use of emergency departments.

Delays in care and additional costs incurred in ER visits are a drain on health care resources. Several studies have estimated that costs of care in nonemergency, nonprimary care clinics are $279 to $460 less per visit than ER costs for similar cases.

“Extended hours have become a big concept of how to bring our practice to the people, to make it more available to the people,” explained SFMS member Sophia Mirviss, MD. “It’s for existing patients, and also for people who come home and find themselves sick and really want to be seen but had to work all day. And for people who do not have insurance but want to get their strep throat checked but cannot go to the ER because it’s prohibitively expensive.”

The clinic does not provide ongoing primary care services. It transmits all medical encounters to patients’ primary care physicians via an electronic medical records system so that the primary care physicians retain control of all referrals and follow-up.

The community has embraced this concept; many physicians have been strongly positive in their responses. It has also garnered support from Brown & Toland and other insurers as it has the potential for reducing inappropriate ER and hospital use rates.

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