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International Journal For Equity in... Nov 2022Mobile clinics have been implemented in diverse clinical and geographical settings to provide proximal health care for specific populations. Primary health care mobile...
BACKGROUND
Mobile clinics have been implemented in diverse clinical and geographical settings to provide proximal health care for specific populations. Primary health care mobile clinics have been implemented widely for Indigenous populations, with a paucity of research evaluations around service delivery models internationally. To redress factors impeding service accessibility for Aboriginal and Torres Strait Islander Peoples, Budja Budja Aboriginal Cooperative (Aboriginal Community Controlled Health Organisation located in a small rural town in Victoria, Australia), developed and implemented the Tulku wan Wininn primary health mobile clinic.
METHODS
A qualitative process evaluation methodology was used to explore contextual factors mediating the implementation of the mobile clinic, including the acceptability of the service to health service personnel, external key informants, and Aboriginal and/or Torres Strait Islander clients. A synthesis of international ethical guidelines, (Consolidated Criteria for strengthening reporting of health research involving Indigenous peoples (CONSIDER statement), was prospectively applied to shape the study design and research process. Semi-structured interviews were conducted with participants. Data collection occurred from July 2019 to October 2021. Inductive thematic data analysis was undertaken concurrently with data collection.
RESULTS
Data was collected from 19 participants which included 12 health service personnel and key informants, and 7 Aboriginal clients. In total, data from 22 interviews were included as interviews with three clients were undertaken twice. Four themes were developed: considerations for early implementation, maintaining face-to-face services during COVID-19, acceptability as a model of service delivery, and maintaining the mobile clinic as a service delivery model.
CONCLUSION
Evidence supporting the acceptability of a primary health care mobile clinic for Aboriginal Peoples residing in rural Victoria is provided. Despite the experience of early implementation challenges and adaptations, the mobile clinic addressed known transport and cultural barriers to accessing primary health care services. In the context of COVID-19 lockdowns, the mobile clinic was valued for the provision of face-to-face care for Aboriginal clients. Key issues for maintaining the mobile clinic include health workforce and funding. Findings are of value to other organizations seeking to implement a primary health mobile clinic service delivery model to redress barriers to accessibility experienced by the communities they serve.
Topics: Humans; Indigenous Peoples; Health Services, Indigenous; Mobile Health Units; Native Hawaiian or Other Pacific Islander; COVID-19; Communicable Disease Control; Victoria
PubMed: 36384739
DOI: 10.1186/s12939-022-01768-4 -
Asian Pacific Journal of Cancer... May 2021The aim of this study is to demonstrate the feasibility; mention the challenges encountered and highlight the success of implementing a community-based mobile cervical...
BACKGROUND
The aim of this study is to demonstrate the feasibility; mention the challenges encountered and highlight the success of implementing a community-based mobile cervical cancer-screening program in rural India.
METHODS
Communities were mobilized through extensive peer education and by screening in existing community spaces using a mobile clinic model. An initial "screen and treat" protocol was transitioned to "screen, test, and treat" using Pap smears for confirmatory testing, and cryotherapy or Loop Electrosurgical Excision Procedure (LEEP) for treatment. We trained 50 Peer Educators and conducted 190 screening camps in 58 locations.
RESULTS
Of 3,821 registered women, 3,544 (92.8%) accepted screening. Overall, 440/3544 (12.4%, 95% CI 11.3-13.5%) women had VIA-positive lesions. Under "screen and treat", 56/156 (35.9%) women accepted same-day treatment. Under "screen, test, and treat", 555/762 (72.8%) women received a Pap smear. Overall, 83 women underwent cryotherapy (n=56) and LEEP (n=27). Of those, 49 (59.0%) participants were followed up, with normal VIA results up to two years after treatment. In summary, the peer educators promoted awareness of cervical cancer and helped in gaining buy-in from communities. Acceptance of same-day treatment was low and accompanied by loss to follow-up, limiting the utility of VIA in these studies.
CONCLUSIONS
Mobile infrastructure utilized in community spaces brought screening directly to rural women. Culturally appropriate methods to increase linkage to treatment and additional screening options such as HPV DNA testing should be explored.
Topics: Adult; Early Detection of Cancer; Female; Follow-Up Studies; Health Plan Implementation; Humans; India; Mobile Health Units; Papanicolaou Test; Prognosis; Rural Population; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 34048166
DOI: 10.31557/APJCP.2021.22.5.1393 -
PLoS Neglected Tropical Diseases Apr 2020During the West African Ebola Virus Disease (EVD) epidemic from 2014 to 2016, a variety of technologies travelled considering the context of the emergency: a highly...
During the West African Ebola Virus Disease (EVD) epidemic from 2014 to 2016, a variety of technologies travelled considering the context of the emergency: a highly contagious fast-killing disease outbreak with no known remedy and a rapidly increasing number of cases. The Ebola-Tx clinical trial tested the efficacy of Convalescent Plasma (CP) as a treatment for EVD in Guinea. This paper is based on ethnographic research in the Ebola-Tx trial and focuses on the introduction of a mobile plasma collection centre, referred to as the 'Plasma Mobile', equipped with plasmapheresis and pathogen inactivation technologies, as well as how the transfer itself of this technology entailed complex effects on CP donors as trial participants (i.e. providers of the therapeutic product), directly involved staff and more broadly on the trial implementation as a whole. The transfer led to the emergence of a dimension of hope as CP donors hoped that the plasma would cure and, as providers of the therapeutic, hoped it would decrease their stigmatization and the economic impact of the disease. We conclude that, in light of the intricate effects that the transfer of such health technology can entail-in the localization to the specific context, as well as in the consequences they can have on actors involved in the implementation of such technologies-global health technologies should be put at the services of next epidemic and pandemic (preparedness) on condition that they are accompanied by an understanding of the technologies' own cultural meanings and social understandings.
Topics: Biomedical Technology; Blood Donors; Female; Guinea; Hemorrhagic Fever, Ebola; Humans; Male; Mobile Health Units; Motivation; Patient Participation; Plasmapheresis; Survivors; Technology Transfer
PubMed: 32320398
DOI: 10.1371/journal.pntd.0008206 -
Journal of the American Medical... Nov 2020During the surge of Coronavirus Disease 2019 (COVID-19) infections in March and April 2020, many skilled-nursing facilities in the Boston area closed to COVID-19...
During the surge of Coronavirus Disease 2019 (COVID-19) infections in March and April 2020, many skilled-nursing facilities in the Boston area closed to COVID-19 post-acute admissions because of infection control concerns and staffing shortages. Local government and health care leaders collaborated to establish a 1000-bed field hospital for patients with COVID-19, with 500 respite beds for the undomiciled and 500 post-acute care (PAC) beds within 9 days. The PAC hospital provided care for 394 patients over 7 weeks, from April 10 to June 2, 2020. In this report, we describe our implementation strategy, including organization structure, admissions criteria, and clinical services. Partnership with government, military, and local health care organizations was essential for logistical and medical support. In addition, dynamic workflows necessitated clear communication pathways, clinical operations expertise, and highly adaptable staff.
Topics: Aged; Betacoronavirus; Boston; COVID-19; Cooperative Behavior; Coronavirus Infections; Female; Humans; Male; Middle Aged; Mobile Health Units; Pandemics; Personnel Staffing and Scheduling; Pneumonia, Viral; SARS-CoV-2; Skilled Nursing Facilities; Subacute Care
PubMed: 33138938
DOI: 10.1016/j.jamda.2020.09.003 -
Bulletin of the World Health... Jun 2021To assess the implementation of a mobile dispensing service to improve opioid users' access to methadone maintenance therapy.
OBJECTIVE
To assess the implementation of a mobile dispensing service to improve opioid users' access to methadone maintenance therapy.
METHODS
In March 2019, we started mobile methadone dispensing in an urban underprivileged locality in Delhi, India. The doctor was available only at the main community drug treatment clinic for clinical services, while the nurse dispensed methadone from a converted ambulance. We involved patients in identifying community leaders for sensitization and in deciding the location and timings for dispensing. We conducted a retrospective chart review of the programme data collected during delivery of clinical services. We compared the numbers of patients registered for methadone therapy and their retention and adherence to therapy in the 12-month periods before and after implementation of the mobile service.
FINDINGS
The number of patients registered for therapy at the clinic increased from 167 in the year before implementation to 671 in the year after. A significantly higher proportion of patients were retained in therapy at 3, 6 and 9 months after enrolment; 9-month retention rates were 19% (32/167 patients) and 45% (44/97 patients) in the year before and after implementation, respectively. There was no significant difference in patients' adherence to therapy between the two periods. Challenges included providing suitable dispensing hours for patients in employment and concerns of local community near to the dispensing sites.
CONCLUSION
It is feasible to dispense methadone by a mobile team in an urban setting, with better retention rates in therapy compared with dispensing through a stationary clinic.
Topics: Adult; Analgesics, Opioid; Female; Health Plan Implementation; Humans; India; Male; Methadone; Middle Aged; Mobile Health Units; Opiate Substitution Treatment; Opioid-Related Disorders; Program Evaluation; Retrospective Studies; Treatment Outcome
PubMed: 34108752
DOI: 10.2471/BLT.20.251983 -
British Dental Journal Sep 2022Introduction As a means of targeting vulnerable populations to offer care outside the traditional clinical setting, mobile clinics exist that permit clinical teams to...
Introduction As a means of targeting vulnerable populations to offer care outside the traditional clinical setting, mobile clinics exist that permit clinical teams to travel into the community to provide dental care.Aims To highlight some of the inequalities faced by vulnerable populations, to discuss the benefits of a mobile dental unit (MDU) and how it may address some of these inequalities, and to reflect on some of the achievements of the Bradford MDU.Vulnerable populations Vulnerable communities may include the homeless population, those affected by substance misuse, those suffering with mental health problems, asylum seekers, or an amalgamation. Such groups are likely to have lower expectations of healthcare and may not seek help until oral disease is advanced, with a large proportion likely to have already lost their teeth.Bradford MDU The MDU owned by Bradford Community Dental Service is unique in both its longevity of service and populations it serves, and has been providing an outreach dental service to the vulnerable populations of Bradford for the last 16 years. Whilst the COVID-19 pandemic suspended services during the thick of lockdown, the Bradford MDU is slowly re-opening its services, so the care received by these vulnerable populations is no longer compromised.
Topics: COVID-19; Communicable Disease Control; Humans; Mobile Health Units; Pandemics; Vulnerable Populations
PubMed: 36151183
DOI: 10.1038/s41415-022-4981-4 -
BMC Health Services Research Jun 2019In the last decade, mobile radiography services have been introduced in nursing homes in several countries. Earlier research found an underutilisation of diagnostic...
BACKGROUND
In the last decade, mobile radiography services have been introduced in nursing homes in several countries. Earlier research found an underutilisation of diagnostic imaging among nursing home residents. However, the effects of introducing mobile radiography services on the use of diagnostic imaging are unknown. The purpose of this study was to determine the utilisation of diagnostic imaging among nursing home residents and if there are any differences between hospitals with and without a mobile radiography service.
METHODS
Data for 2015 were collected from the radiological information systems of 11 hospitals. The data included information on the anatomical region/organ/organ system, modality, and information on where the examination took place. Using nursing home beds as a proxy for nursing home residents' differences in the use of diagnostic imaging in areas with hospitals with and without mobile radiography services were analysed. The chi-squared test was used to compare the areas.
RESULTS
From 11,066 examinations of nursing home residents, 87% were plain radiographs, 8% were CT scans, and 4% were ultrasound examinations. In areas with mobile radiography services, there was a significantly higher proportion of diagnostic imaging used per nursing home bed, 50% per bed compared to 36% per bed in areas without; p = < 0.001. Furthermore, in areas with mobile radiography services, there was a significantly lower proportion of CT and ultrasound used per nursing home bed, 2.5 and 1.4% respectively per bed compared to 4.7 and 2.2% respectively per bed in areas without; p = < 0.001.
CONCLUSIONS
This study demonstrate a lower use of radiology by nursing home residents compared to the general population, and indicates that mobile radiography services increase the level closer to the user rate in the general population. The proportions of plain radiographs are significantly higher in areas with a mobile radiography service, while the proportion of more advanced imaging techniques such as CT and ultrasound are lower. The higher use of diagnostic imaging is most likely appropriate because of higher morbidity and lower use of diagnostic imaging among nursing home residents, compared to the general population. Further research is necessary on how to improve diagnostic imaging services for nursing home residents.
Topics: Aged; Aged, 80 and over; Female; Health Services Research; Humans; Male; Mobile Health Units; Nursing Homes; Patient Acceptance of Health Care; Radiography
PubMed: 31242914
DOI: 10.1186/s12913-019-4276-x -
Archives of Cardiovascular Diseases Dec 2019
Topics: Cause of Death; Delivery of Health Care, Integrated; Extracorporeal Membrane Oxygenation; Humans; Mobile Health Units; Myocardial Infarction; Recovery of Function; Time-to-Treatment; Treatment Outcome
PubMed: 31708439
DOI: 10.1016/j.acvd.2019.10.003 -
PloS One 2018To explore the operational feasibility of using mobile health clinics to reach the chronically underserved population with maternal and child health (MCH) services in...
OBJECTIVE
To explore the operational feasibility of using mobile health clinics to reach the chronically underserved population with maternal and child health (MCH) services in Tanzania.
DESIGN
We conducted fifteen key informant interviews (KIIs) with policy makers and district health officials to explore issues related to mobile health clinic implementation and their perceived impact.
MAIN RESULTS
Policy makers' perspective indicates that mobile health clinics have improved coverage of essential maternal and child health interventions; however, they face financial, human resource-related and logistic constraints. Reported are the increased engagement of the community and awareness of the importance of MCH services, which is believed to have a positive effect on uptake of services. Key informants (KIs)' perceptions and opinions were generally in favour of the mobile clinics, with few cautioning on their potential to provide care in a manner that promotes a continuum of care. Immunization, antenatal care, postnatal care and growth monitoring all seem to be successfully implemented in this mode of service delivery. Nevertheless, all informants perceive mobile clinics as a resource intensive yet unavoidable mode of service delivery given the current situation of having women and children residing in remote settings.
CONCLUSION
While the government shows the clear motive, the need and the willingness to continue providing services in this mode, the plan to sustain them is still a puzzle. We argue that the continuing need for these services should go hand in hand with proper planning and resource mobilization to ensure that they are being implemented holistically and to promote the provision of quality services and continuity of care. Plans to evaluate their costs and effectiveness are crucial, and that will require the collection of relevant health information including outcome data to allow sound evaluations to take place.
Topics: Administrative Personnel; Delivery of Health Care; Evaluation Studies as Topic; Female; Health Services Accessibility; Humans; Interviews as Topic; Maternal Health Services; Medically Underserved Area; Mobile Health Units; Pregnancy; Prenatal Care; Tanzania; Telemedicine
PubMed: 30192851
DOI: 10.1371/journal.pone.0203588 -
BMC Research Notes Nov 2013The mobile medical unit/polyclinic (MMU/PC) was an essential part of the medical services to support ill or injured Olympic or Paralympics family during the 2010 Olympic...
Creating a gold medal Olympic and Paralympics health care team: a satisfaction survey of the mobile medical unit/polyclinic team training for the Vancouver 2010 winter games.
BACKGROUND
The mobile medical unit/polyclinic (MMU/PC) was an essential part of the medical services to support ill or injured Olympic or Paralympics family during the 2010 Olympic and Paralympics winter games. The objective of this study was to survey the satisfaction of the clinical staff that completed the training programs prior to deployment to the MMU.
METHODS
Medical personnel who participated in at least one of the four training programs, including (1) week-end sessions; (2) web-based modules; (3) just-in-time training; and (4) daily simulation exercises were invited to participate in a web-based survey and comment on their level of satisfaction with training program.
RESULTS
A total of 64 (out of 94 who were invited) physicians, nurses and respiratory therapists completed the survey. All participants reported favorably that the MMU/PC training positively impacted their knowledge, skills and team functions while deployed at the MMU/PC during the 2010 Olympic Games. However, components of the training program were valued differently depending on clinical job title, years of experience, and prior experience in large scale events. Respondents with little or no experience working in large scale events (45%) rated daily simulations as the most valuable component of the training program for strengthening competencies and knowledge in clinical skills for working in large scale events.
CONCLUSION
The multi-phase MMU/PC training was found to be beneficial for preparing the medical team for the 2010 Winter Games. In particular this survey demonstrates the effectiveness of simulation training programs on teamwork competencies in ad hoc groups.
Topics: Adult; Clinical Competence; Data Collection; Education, Medical, Continuing; Emergency Medical Services; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Mobile Health Units; Patient Care Team; Personal Satisfaction; Sports; Sports Medicine
PubMed: 24225074
DOI: 10.1186/1756-0500-6-462