Uncertainty about impact demands careful evaluation and policy making

Papers p 928

Walk-in clinics have existed in Canada since the late 1970s, but the evidence on who uses them and why, and their effectiveness and economic impact, is disconcertingly sparse. Of the nine primary studies cited in a review of walk-in clinics in Canada, published in this issue of the BMJ (p 928), six were surveys of patients attending walk-in clinics, emergency departments, or general practices; one was a review of the clinical records of patients attending an after hours clinic; one surveyed staff informants at walk-in clinics about organisational arrangements and services; and one compared the costs of treatment at walk-in clinics, general practices, and emergency departments using data on fee for service claims from a provincial health insurance plan.1 All but two studies were based on a single walk-in or after hours clinic or on samples of patients drawn from one or a small number of general practices. Most studies provided data from the early 1990s …