As president of the Maryland chapter of the American Academy of Pediatrics and its over 900 member physicians statewide, I am writing to express support for Dr. Jeffrey Cain's concerns surrounding pharmacy based clinics in your article, "The drugstore clinics debate" and their impact on patient centered medical homes.

When children are seen in pharmacy based clinics, they are intrinsically not receiving the level of care provided by the child's primary care doctor. The medical home is best described as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible and focused on quality and safety. It has become a widely accepted model for how primary care should be organized and delivered throughout the health care system. Episodic care in drugstore clinics cannot meet these standards since these clinics do not have access to the child's comprehensive medical record. As part of a comprehensive approach to patient care, primary care offices have availability of same day appointments to see children with acute conditions and can provide the same service as a drug store clinic, more likely at a lower cost as unnecessary tests can frequently be avoided by having the complete medical record at the time of a visit.

As pediatricians, we believe that children are best treated by their primary care physician in a patient centered medical home and that episodic, fragmented care only adds to increasing health costs.

Dr. Scott Krugman, Baltimore

The writer is president of the Maryland chapter of the American Academy of Pediatrics.