Mobile Clinics: Optimizing Access to Preventive Health Care Services in Haitian Communities

Healthy People 2020 and the Affordable Care Act aim to increase access to care, particularly preventive care and care management services. In fulfillment of these goals, mobile clinics have been utilized to reach out to community members of underserved areas to bring these services to them.

In a recent study, the researchers Song, Hill, Bennet, Vavasis, and Oriol (2013) sought to evaluate the effectiveness of mobile clinics in improving patient care outcomes and lowering patient care cost. In the process, they compared their findings with the exorbitant costs associated with preventable emergency visits.

The researchers looked into the data of 5,900 community members who received free screening and culturally appropriate counseling for blood pressure at the Family Van Mobile Clinic from June 2010 to July 2012 in Massachusetts. About 80% of these community members living in underserved areas obtained a high school diploma. Thirty-nine per cent of them spoke primarily Creole, Spanish, or another foreign language. The lack of insurance and prior annual physical examination spanning a length of 2 years or more was documented in about 10 percent of cases.

Among the 5,900 community members who benefited from the free screening and counseling services for blood pressure, 1,134 community members returned for their follow-up visits. In this selected sample of 1,134 compliant community members, 237 were found to be hypertensive at their first visit with an average blood pressure of 143.2/88.1 mmHg. On average, these patients received preventive services inside the van six times. In total, "ninety-six percent received health literacy education and coaching about cardiovascular health, 89 percent received nutritional counseling, and 49 percent discussed obesity prevention with clinic staff. All received screenings and support for other pertinent issues, such as mental health and health insurance." The researchers anticipated that these community members could have also received services in other health care settings while using the services offered by the Family Van Mobile Clinic. Thus, they used statistical or control methods to reduce the impact that this situation and others could have on the blood pressure level of the community members when measured during their second visit.  After controlling for these anticipated factors or variables, they noted a constant decrease in blood pressure levels at all subsequent visits averaging 129.3/78.3 mmHg.

To evaluate how much preventable spending potentially occurred as a result of these preventive services administered to these community members, the researchers utilized several methods of calculation. One method consisted of taking into account the number of possibly avoided emergency visits, based on the community members responses at their first visits to the Family Van Mobile Clinic, which revealed that they would have otherwise gone to the emergency room. Considering the estimated cost of $474 for each emergency visit in the state of Massachusetts, the researchers calculated that a total of $1.4 million was saved in health care spending due to this initiative. Additional spending reductions occurred as a result of the use of this mobile clinic that catered to the needs of community members in the six underserved areas.

In their analysis, the authors noted that the need for mobile clinic is crucial to optimize service delivery coverage even in states with "near-universal insurance coverage" such as Massachusetts. The financial potentials of implementing this strategy on a wider scale can be huge. This strategy is worth being applied for the screening and lifestyle management of other conditions such as diabetes and hypercholesterolemia.

Future policies will need to reflect these recommendations for a healthier nation and more sustainable health care system.

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Reference

1. Song, Z., Hill, C., Bennet, J., Vavasis, A., & Oriol, N. E. (2013). Mobile clinic in Massachusetts associated with cost savings from lowering blood pressure and emergency department use. Health Affairs, 32(1), 36-44. doi: 10.1377/hlthaff.2011.1392