Mobile Population Based Care Solutions from Canada and Finland

Abstract

This paper investigates creative, mobile population-based medical solutions with integrated care delivery strategies in two different contexts. British Columbia’s two-truck mobile medical unit operates in both remote and highly urban environments in Canada, serving at-risk Canadian populations in areas ranging from remote First Nations communities to downtown Vancouver homeless people suffering from overdoses in the deadly Fentanyl crisis. The highly adaptable unit can mobilize at a day’s notice and can travel by road or by ferry. The other investigated mobile care solution is located in depopulating South Karelia in Finland, where a highly customized social and healthcare service for seniors has been created as part of the EKSOTE initiative. (EKSOTE stands for Etelä-Karjalan sosiaali- ja terveyspiiri – the South Karelia social and health district). The service provides public health services, urgent primary care, mental health services, chronic disease management, psychosocial rehabilitation, life skills training and assessment as well as home health support for seniors, populations at risk and clients in remote communities. Based on interviews with experts (clinical planners, public health managers) and an exploration of statistics and policy documents, we argue that both examples demonstrate different but exceptionally versatile mobile services with integrated care strategies provided by staff with broad-based competencies. Importantly, these units cover services that have been identified as significant gaps in care in rural or hard-to-reach populations that otherwise would remain untreated. Moreover, as accelerating urbanization is resulting in the depopulation of other areas, mobile services are a viable option in areas experiencing migration losses that no longer can support regular clinics. Income polarization and de-industrialization have increased homelessness, disenfranchisement, addictions and misery in urban areas. The approach of mobile services is by definition patient-centered care as the service is physically brought to the service user, and not the service user to the practitioner. The multi-disciplinary care offered automatically shifts towards a holistic direction as opposed to ‘pay for service’ systems where users can be limited on how many issues can be discussed during one consultation. Case management improves as different members of the care teams may all see the user on the same visit. We conclude that as a planning opportunity, by providing platforms and service networks that tie into existing (even diminishing) infrastructures, mobile, integrated care services provide important surge capacity and opportunities for highly customized services for clinics tailored to complex events and populations (refugees, outbreaks, events). Like humanitarian relief organizations such as Médecins Sans Frontières <https://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwisvovV1u_qAhWL_qQKHYsdCYsQFjAAegQIARAB&url=https%3A%2F%2Fwww.msf.org%2F&usg=AOvVaw1wofliiSKPaBTvJzXXAVND> (MSF), local mobile health services are also relevant in response to emergencies, natural disasters and adverse weather events.