Mobile Clinic Program Research Articles

Evaluation of a combined school-based vision screening and mobile clinic program

Effective vision screening programs for children require follow-up with eye care providers, but studies demonstrate poor follow-up rates after failed screenings. Programs have attempted to address this issue by providing free examinations and glasses after failed screenings. This study presents data from a mobile clinic program that provides instrument-based vision screening, eye examinations, and free glasses directly to children at school. Between 2018 and 2021, a nonprofit organization provided in-school instrument-based screening and noncycloplegic examinations and refractions in elementary, middle, and high schools. Deidentified screening and clinic data were reviewed retrospectively. Information about each school regarding total student enrollment, enrollment based on race, and number of economically disadvantaged students was obtained from the Virginia Department of Education. In the 2019-2020 school year, 14,006 students from 58 schools were screened, and 4,238 (30.3%) were referred. The percentage of economically disadvantaged students was positively correlated to referral rate (R2 = 0.406). Between 2019 and 2020, the mobile clinic examined 3,095 students from the same 58 schools. Of these, 72.9% were prescribed glasses, and 16.3% were referred for a more comprehensive eye examination and treatment. Students were also diagnosed with cataracts, nystagmus, amblyopia, and strabismus. A combined screening program and mobile clinic traveling directly to schools can provide a pipeline for delivering eye care to vulnerable populations.

Evaluation of a combined school-based vision screening and mobile clinic program

Uncorrected refractive error can lead to lowered academic performance. Many children depend on state-mandated school vision screening programs. Effective screening programs require follow-up with eye care providers, but studies demonstrate poor follow-up rates after failed screenings. Programs have attempted to mediate this issue by providing free examinations and glasses after failed screenings. This study presents data from a mobile clinic program that provides instrument-based vision screening, eye examinations, and free glasses directly to children at school.

Driving to Reduce Socioeconomic Barriers to Latent Tuberculosis Infection Care: A Mobile Pediatric Treatment Program.

Tuberculosis (TB) disease causes significant morbidity, mortality, and public health impacts. Prevention of latent tuberculosis infection (LTBI) in children reduces the burden of disease. The Texas Children's Mobile Clinic Program's (TC-MCP's) mission is to provide high-quality health care to underresourced children within the community setting. The TC-MCP serves a large foreign-born pediatric population. The need for an LTBI treatment program arose when caring for this high-risk population. The TC-MCP providers collaborated with nationally recognized pediatric TB experts as well as local health departments that provide medications free of cost. The TC-MCP placed tuberculin skin tests (TSTs) on patients with risk factors for TB. TST-positive patients had an interferon-γ release assay (IGRA) performed. IGRA-positive patients had a chest radiograph (CXR) obtained. Children with positive IGRA and normal CXR were included in the LTBI program, which consisted of TC-MCP outpatient visits and 12 once-weekly doses of isoniazid/rifapentine (3HP) provided by local health departments. From January 2018 to March 2020, 785 TC-MCP patients received TSTs, of which 38 (4.8%) were positive. An additional 7 positive TSTs were identified from outside facilities. In addition to the 45 positive TSTs, 4 TC-MCP patients with follow-up difficulties had IGRAs done as the initial test. Of these 49 IGRAs done, 13 patients had a positive IGRA. An additional 6 patients with positive IGRAs from outside facilities were identified. Nineteen patients (36.5%) were diagnosed with LTBI; of whom, 18 completed 3HP therapy through the TC-MCP. Eighty-three percent (15/18) completed at least 2 in-person visits. Underresourced children at higher risk for TB benefit from a mobile clinic's unique reach. By utilizing community partnerships, mobile clinics can successfully fill gaps in the health care system where marginalized populations may be missed.

Initiation of hepatitis C treatment in two rural Rwandan districts: a mobile clinic approach

BackgroundTo eliminate hepatitis C, Rwanda is conducting national mass screenings and providing to people with chronic hepatitis C free access to Direct Acting Antivirals (DAAs). Until 2020, prescribers trained and authorized to initiate DAA treatment were based at district hospitals, and access to DAAs remains expensive and geographically difficult for rural patients. We implemented a mobile clinic to provide DAA treatment initiation at primary-level health facilities among people with chronic hepatitis C identified through mass screening campaigns in rural Kirehe and Kayonza districts.MethodsThe mobile clinic team was composed of one clinician authorized to manage hepatitis, one lab technician, and one driver. Eligible patients received same-day clinical consultations, counselling, laboratory tests and DAA initiation. Using clinical databases, registers, and program records, we compared the number of patients who initiated DAA treatment before and during the mobile clinic campaign. We assessed linkage to care during the mobile clinical campaign and assessed predictors of linkage to care. We also estimated the cost per patient of providing mobile services and the reduction in out-of-pocket costs associated with accessing DAA treatment through the mobile clinic rather than the standard of care.ResultsPrior to the mobile clinic, only 408 patients in Kirehe and Kayonza had been initiated on DAAs over a 25-month period. Between November 2019 and January 2020, out of 661 eligible patients with hepatitis C, 429 (64.9%) were linked to care through the mobile clinic. Having a telephone number and complete address recorded at screening were strongly associated with linkage to care. The cost per patient of the mobile clinic program was 29.36 USD, excluding government-provided DAAs. Providing patients with same-day laboratory tests and clinical consultation at primary-level health facilities reduced out-of-pocket expenses by 9.88 USD.ConclusionThe mobile clinic was a feasible strategy for providing rapid treatment initiation among people chronically infected by hepatitis C, identified through a mass screening campaign. Compared to the standard of care, mobile clinics reached more patients in a much shorter time. This low-cost strategy also reduced out-of-pocket expenditures among patients. However, long-term, sustainable care would require decentralization to the primary health-centre level.

Foot Health Assessment and Problem Identification in a Dominican Batey Community: A Descriptive Study.

Foot problems can adversely impact foot function and quality of life. Foot problems are often overlooked, particularly in populations with limited health care access. Little is known about the foot health of Haitian immigrants who live and work in the bateyes (rural sugarcane villages) of the Dominican Republic. These immigrant workers may experience foot problems that could affect foot function and the ability to work and provide for their families. Cross-sectional, exploratory, descriptive study design. A convenience sample of adults was recruited from an ongoing community-based participatory research project evaluating a mobile hypertension screening and treatment clinic program in 11 Dominican batey communities. Foot health was assessed using the Foot Problems Checklist, a 24-item survey instrument developed for this study based on a review of the literature and foot clinician expertise. A certified foot care nurse recorded foot health data on the Foot Problems Checklist via visual and physical inspection. Study participants were 25 females and 16 males, aged 18 to 90 years, and all had at least one foot health problem. The most common foot problems were calluses (78%), dry skin (76%), thick nails (59%), jagged nails (29%), long/overgrown nails (17%), and skin fissures (12%). While the foot problems we observed were not considered serious, they could become progressively debilitating and be prevented with proper self-management guided by appropriate knowledge and skills and available supplies. We recommend the development and testing of foot care self-management interventions deliverable via mobile clinics to increase access and improve foot health outcomes.

Geographical Influence of Mobile Clinics in the Southern United States

To develop a mobile clinic influence index, which could allow mobile clinic managers to prioritize geographic regions and allocate resources systematically. The mobile clinic primary care service index was constructed taking into account miles traveled by the mobile clinic, the speed of the mobile clinic, number of primary care providers available in a primary care service area (PCSA), the total population in a PCSA, and the number of primary care providers per mobile clinic program. To illustrate the application of the mobile clinic influence index, we use the case of selected primary care mobile clinic programs operating in North Carolina and Florida. A survey of selected mobile clinic programs from Texas, Georgia, Florida, and North Carolina, in rural and urban zip codes. PCSAs in various counties in North Carolina and Florida experienced varying degrees of additive effects of having mobile clinic providers service these areas. The mobile clinics in these counties were therefore influential in delivering critical primary healthcare services to at-risk populations. The index provides a valuable unit of measure to enable program managers of primary care mobile clinics to allocate resources as needed.

Evaluating Partial Series Childhood Vaccination Services in a Mobile Clinic Setting.

This study aims to evaluate the cost-benefit of vaccination services, mostly partial series administration, provided by a mobile clinic program (MCP) in Houston for children of transient and low-income families. The study included 469 patients who visited the mobile clinics on regular service days in 2 study periods in 2014 and 836 patients who attended vaccination events in the summer of 2014. The benefit of partial series vaccination was estimated based on vaccine efficacy/effectiveness data. Our conservative cost-benefit estimates show that, compared with office-based settings, every dollar spent on vaccination by the MCP would result in $0.9 societal cost averted as an incremental benefit in regular service days and $3.7 during vaccination-only events. To further improve the cost-benefit of vaccination services in the MCP, decision-makers and stakeholders may consider improving work efficiency during regular service days or hosting more vaccination events.

Analysis of Annual Costs of Mobile Clinics in the Southern United States

IntroductionMobile clinics provide an efficient manner for delivering healthcare services to at-risk populations, and there is a need to understand their economics. This study analyzes the costs of operating selected mobile clinic programs representing service categories in dental, dental/preventive, preventive care, primary care/preventive, and mammography/primary care/preventive.MethodsThe methodology included a self-reported survey of 96 mobile clinic programs operating in Texas, North Carolina, Georgia, and Florida; these states did not expand Medicaid and have a large proportion of uninsured individuals. Data were collected over an 8-month period from November 2016 to July 2017. The cost analyses were conducted in 2018, and were analyzed from the provider perspective. The average annual estimated costs; as well the costs per patient in each mobile clinic program within different service delivery types were assessed. Costs reported in the study survey were classified into recurrent direct costs and capital costs.ResultsResults indicate that mean operating costs range from about $300 000 to $2.5 million with costs increasing from mammography/primary care/preventive delivery to dental/preventive. The majority of mobile clinics provided dental care followed by dental/preventive. The cost per patient visit for all mobile clinic service types ranged from $65 to $529, and appears to be considerably less than those reported in the literature for fixed clinic services.ConclusionThe overall costs of all delivery types in mobile clinics were lower than the costs of providing care to Medicare beneficiaries in federally funded health centers, making mobile clinics a sound economic complement to stationary healthcare facilities.

Enough Zzzs? Sleep, Snoring, and Sleep Apnea Evaluation in Underinsured Overweight and Obese Children

Category/Date Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Pediatric Research: Professional Role & Health Promotion and Disease Prevention, Presented at NAPNAP's 40th National Conference on Pediatric Health Care, March 8, 2019, New Orleans, LA. Background The amount and quality of sleep children get each night is important to their health and well-being. Insufficient sleep and sleep disorders are frequently diagnosed in overweight and obese children. Sleep disorders, like sleep apnea, require referral to specialists for evaluation, diagnosis, and treatment. Uninsured families are less likely to seek preventative medical care because of high cost, lack of established care, transportation issues, and lack of insurance access. Therefore, uninsured children are less likely to visit providers for check-ups to receive sleep counseling, appropriate evaluation for sleep disorders, and referrals to specialist for sleep disorders when necessary. Objective To evaluate sleep quantity, snoring, and frequency of referrals to specialists for sleep apnea in uninsured, primarily Hispanic, overweight and obese children. Methods With IRB approval, a paper survey was given to 45 parents whose children were enrolling in a lifestyle modification program on a mobile clinic program that cares for uninsured children in Houston, TX. Children were recruited for the one month program because they were identified as overweight or obese at a well-child visit. Results The parents of 45 overweight/obese uninsured children ages 8-18 (42% male) were surveyed. 73% of the families surveyed had an annual family income less than $40,000. Only 4% reported that their child had been diagnosed previously with a chronic medical condition. The subjects were 91% Hispanic and Spanish was primary language spoken at home for 73% of families. Average reported number of hours of sleep at night: 6 hours or less (11%), 7-8 hours (67%), 9-10 hours (18%), and more than 10 hours (4%). Forty-four percent of parents reported that their child snores regularly. Although all patients enrolled were overweight or obese, there were no statistically significant differences between BMI and hours of sleep or frequency of snoring. Of those that reportedly snore, only 6% had received formal evaluation for sleep apnea. Conclusions Uninsured children may not be sleeping enough quality hours at night which is an understood risk factor for obesity. Overweight and obese uninsured children who snore may not receive sleep evaluation with a specialist due to barriers like high cost, poor insurance access, lack of established care, and transportation barriers. Further research is needed to understand how to reach uninsured children and provide recommended sleep counseling and evaluation for sleep disorders.

Reaching Uninsured Overweight and Obese Children Through the FitKids Mobile Lifestyle Modification Program: Lessons Learned.

The US prevalence of childhood obesity remains high with ~ 1 in five children diagnosed with obesity, and rates of obesity are likely higher in uninsured and Medicaid populations than in those with private insurance. To understand the impact of an obesity intervention, an established mobile clinic program conducted a study to determine whether a FitKids Mobile Lifestyle Modification Program could reach overweight and obese uninsured children. Eighty-six children (ages 8-18years) participated in the FitKids study over two trial periods. The first trial consisted of four total visits, but subsequent visits after the initial visit had poor turnout. Through telephonic interviews, parents described positive aspects of the program: (1) providers' individual attention to their child, (2) increased knowledge about obesity, nutrition, and diet, (3) and parent and child were motivated to be more active. The most common barriers noted for return visits were (1) personal/family factors, (2) scheduling issues, and (3) distance to the clinic. As quality improvement, for the second trial, total number of visits was reduced from 4 to 3 visits and reminder calls were instituted. Percentage of children who returned for the third visit (67.5% for Trial 1 and 62.5% for Trial 2) was not improved despite quality improvement interventions. Mobile clinics provide a unique solution to reach underserved overweight and obese children to help them create a more active and healthy lifestyle, but more research is needed to understand how best to optimize programs.

Utilizing Lean Principles to Improve Immunization Administration Efficiency in a Pediatric Mobile Clinic Program.

Introduction:Mobile clinics are vital health care delivery systems because they provide care to those who may not have access otherwise. Unfortunately, clinic flow on mobile clinics is often chaotic and inherently inefficient. Lean is a customer-centric methodology used in industries like health care to continuously improve processes by eliminating waste. The purpose of this project was to use lean principles to improve efficiency, as measured by total time spent receiving services, so that more underserved patients could receive needed immunizations.Methods:Using a certified lean expert, lean principles were applied to the mobile clinic program to uniformly organize the program, simplify registration processes, and standardize clinic procedures. Time study data were collected prospectively on a total of 309 patients for 2-week periods both before and after application of lean principles. Staff used a standardized time study form to record patient visit times. Pre- and postintervention data were analyzed using unpaired t tests and nonparametric Mann-Whitney tests as deemed appropriate.Results:Using lean principles significantly reduced total times spent for 1-, 2-, and 4-children families. Wait times for 1- and 4-children families were also significantly decreased. Lastly, times spent on board the mobile clinic to receive immunizations for 1- and 3-children families were significantly decreased.Conclusion:Application of lean principles can improve efficiency by decreasing total time spent for patients receiving vaccine services on pediatric mobile clinics.

Complementary and Alternative Medicine Use in Uninsured Children in Texas.

Use of complementary and alternative medicine (CAM) among US children is 12% according to the 2012 National Health Interview Study. Certain pediatric populations have higher CAM use. We studied an uninsured population because limited access to care likely results in higher CAM use. We surveyed 250 uninsured patients in a free pediatric mobile clinic program. In the largely Hispanic population, rate of CAM use in the preceding 12 months was 45% among children and 59% among parents. Ninety-one percent of children who used CAM had parents who used CAM while only 32% of parents used CAM for themselves but did not use CAM for their children ( P < .001). Seven parents (3%) and 4 children (2%) had ever discussed their CAM use with a physician. Since CAM use is significant in this uninsured population and families do not generally discuss CAM with physicians, health care providers must ask about CAM use and provide guidance.

Prevalence of cutaneous pathological conditions and factors associated with the presence of skin wounds in working equids in tropical regions of Veracruz, Mexico

A wide spectrum of welfare issues is encountered on working equids. The objectives of this study were: (i) to determine the prevalence of cutaneous lesions in working equids in tropical regions of the North-Central of Veracruz State, Mexico, (ii) to identify the most prevalent cutaneous pathological conditions in this population of working equids, and (iii) to identify risk factors associated to the presence of work-related skin wounds. A number of 467 working equids presented for treatment at Donkey Sanctuary Mobile Clinic Program - National Autonomous University of Mexico from seven different villages in the North-Central region of Veracruz State were evaluated. Animals with signs of cutaneous pathology underwent a physical examination and samples were obtained of exudates, hair, and tissue for cytology examination, fungal cultures, and dermo-histopathology examination. The overall prevalence of cutaneous pathological conditions in working equids was 20.6%. The prevalence per species was 22.6% for horses, 18.2% for donkeys, and 14.3% for mules. The most common cause of skin lesions was trauma (abrasions, lacerations, and abscesses) followed in frequency by parasitic dermatitis and sarcoids. No strong associations among species were observed (P > 0.20). Multivariate analysis showed that there was greater association between BCS and age with the presence of skin wounds (P < 0.05). Equids who's BCS was rated as "moderate" as well as adult animals showed significantly more skin wounds compared with the young and the elderly (P < 0.05). These findings can help to develop a better management practices to improve the welfare of equids in tropical regions of Veracruz, Mexico.

Using Program Impact Pathways to Improve Anemia Reduction Programs

Recent evidence of the benefits of iron supplementation during pregnancy to reduce low birth weight and maternal mortality highlights the need for iron supplementation in pregnancy, an intervention known to be efficacious. Despite implementation of anemia reduction programs in many developing countries, the worldwide prevalence of maternal anemia in pregnancy remains over 40%. This suggests limitations in program delivery.To improve the delivery of a large‐scale anemia reduction program delivered through a mobile clinic program in rural Haiti, we designed a “Program Impact Pathway” (PIP) to delineate the mechanisms by which program activities resulted in desired outcomes. Survey data (n=663) from program beneficiaries were used to asses each essential component of the PIP, including consistent distribution of iron folic acid (IFA) at monthly clinics, women's understanding of how and why to IFA and barriers to adherence. Although knowledge about IFA benefits was high, irregular clinic attendance and inconsistent delivery of IFA resulted in a low median number of times women received IFA during pregnancy.Iron supplementation programs will be successful only if all essential elements linking program efforts to desired outcomes are identified and understood. The PIP provides such a method, and the lessons from its use in Haiti can be applied to other such programs.Research support: USAID, NIH/NIDDK

The Use of Mixed Methods Evaluation for Effective Program Scale up

Many international nutrition programs struggle with achieving effectiveness at scale. Requisites for program success at scale include sound program theory, the ability to be adapted by varied implementing organizations in diverse contexts and timely monitoring and evaluation.Our purpose was to identify and resolve bottlenecks for a large maternal and child health mobile clinic program in rural Haiti before national scale up. A participatory workshop based on the Program Assessment Guide was held with staff from all program levels to systematize contextual knowledge of the delivery systems for iron folic acid (IFA) supplements and related behavior change communication. Workshop participants produced an operations research agenda which was implemented in addition to a survey of program beneficiaries and an assessment of anemia prevalence.This research uncovered important constraints that need to be remedied before effective scale up, such as irregularities in the IFA supply chain, inconsistent implementation of clinics and gaps in the monitoring and evaluation system. The operations research clarified the reasons for these problems and the survey characterized clinic access and attendance and IFA behavior. Mixed methods and triangulation of results were critical for insight and staff participation was instrumental for the utilization of findings.Research support: USAID, NIH/NIDDK

The Role of Information, Education, and Communication in Family Planning Service Delivery in Tunisia

In an effort to measure the value of outreach, a prospective study using an experimental comparison group design was implemented in a rural region of Tunisia, where an outreach program had been implemented in 1981 to increase contraceptive prevalence. The main components of the program included the improvement and expansion of rural health care services through mobile clinics, and the implementation of an information, education, and communication (IEC) outreach program. While the program tended to focus on the implementation of the mobile clinics, service statistics suggested that the IEC outreach component in fact accounted for much of the success of the program. The study shows that the addition of outreach to existing services more than doubles the number of new family planning acceptors, and that outreach has a more positive impact on service output than does the creation of new services.