The Sociolance: A mobile clinic requested through emergency medical dispatch center serving socially vulnerable and homeless people in the Capital City of Denmark

Abstract

Introduction Socially vulnerable and homeless peoples’ life situation is characterized by combined social, physical and mental problems resulting in complex health care needs. Yet, they are hard to reach and often do not seek or want help. Consequently, their life expectancy is found to be remarkably lower than for the general populations. In Denmark, the first mobile clinic “the Sociolance” has been operating as a pilot project in the period from December 2015 to August 2017 (with a subsequently extension of the service). The aim of the Sociolance is to assist socially vulnerable and homeless people in the capital city of Denmark, Copenhagen, with social and healthcare problems not requiring an emergency ambulance. The Sociolance is unique at an international level since it combines affiliation with the Emergency Medical Dispatch center, from where it is requested, with performing social outreach work. The Sociolance renders help on the spot and transports users to relevant offers. The aim of this study is two-fold: –to describe the trips of the Sociolance; –to characterize the people using the services of the Sociolance, including describing to what extent the users of the Sociolance accept referrals to social and healthcare services offered by the staff of the Sociolance. Methods Data used for this study were collected in the study period between December 2015 and June 2017 from several sources: –electronically registered data from the emergency medical service database; –record sheets completed by the social workers in contact with the users of the Sociolance; –case reports fulfilled by the staff (social worker and paramedic) daily at the end of each shift. We performed descriptive analyses using frequency distribution indicating the number of observations and percentages, and the mean and interquartile range. Results In total, 2072 transportations were registered in the study period. Of all transportations, 83% were related to requested transportations through the Emergency Medical Dispatch center. A requested transportation took in average 62 minutes (38–80 minutes) including 27 minutes spent with the user at the destination and 15 minutes spent with the user at the hospital. A total of 917 users (77% male) were registered in the study period with over half (58%) of the contacts registered in the street environment. Every third user in contact with the service was affected by alcohol or influenced by drug and around one out of four (26%) were mentally affected. One third were registered as homeless and nearly one out of five (18.6%) users was registered with another ethnicity than Danish. Approximately 40% of the users were connected to the social service system. Nine out of ten users were offered social - and/or healthcare services in contact with the Sociolance and three out of four accepted the offer they received. The users were referred to health care services related to substance abuse (40%), mental illness (20%) and somatic disease (13%), respectively. Nearly one out of four users were offered services related to combined healthcare (substance abuse and/or mental disease and/or somatic illness). Of social care, one out of five users were transported to housing services/shelters. Conclusions The majority of the Sociolance transportations were made by request through the Emergency Medical Dispatch center unleashing resources for the use of emergency ambulances. The population in contact with the Sociolance had often severe combined health and social problems. It was found that, the acceptance of the services offered by the Sociolance was quite high demonstrating it to be an important approach in the effort to target “hard to reach” populations.