Mobile Health Clinic Research Articles

Implementation of a mobile health clinic framework for Hepatitis C virus screening and treatment: a descriptive study

Although treatment for Hepatitis C Virus (HCV) is effective, individuals face access barriers. The utility of mobile health clinics (MHC), effective mechanisms for providing healthcare to underserved populations, is understudied for HCV-related interventions. We aimed to describe implementation of, and factors associated with, screening and treatment via MHCs. Clemson Rural Health implemented a novel MHC program to reach and treat populations at-risk for HCV with a focus on care for uninsured individuals. We examined HCV screening and treatment initiation/completion indicators between May 2021 and January2023. Among 607 individuals screened across 31 locations, 94 (15.5%) tested positive via antibody and viral load testing. Treatment initiation and completion rates were 49.6% and 86.0%, respectively. Among those screened, the majority were male (57.5%), White (61.3%; Black/Hispanic: 28.2%/7.7%), and without personal vehicle as primary transportation mode (54.4%). Injection drug use (IDU) was 27.2% and uninsured rate was 42.8%. Compared to HCV-negative, those infected included more individuals aged 30-44 (52.1% vs. 36.4%, p=0.023), male (70.2% vs. 55.2%, p=0.009), White (78.5% vs. 60.2%, p<0.0001), without personal vehicle (58.5% vs. 43.5%, p=0.028), IDU (83.7% vs. 21.0%, p<0.0001), and uninsured (61.2% vs. 48.8%, p=0.050). Uninsured rates were higher among those initiating compared to not initiating treatment (74.5% vs. 45.3%, p=0.004). The MHC framework successfully reaching its target population: at-risk individuals with access barriers to healthcare. The high HCV screening and treatment initiation/completion rates demonstrate the utility of MHCs as effective and acceptable intervention settings among historically difficult-to-treat populations. Gilead Sciences, Inc., and SC Center for Rural and Primary Healthcare.

Screening for the social determinants of health: Referring patients to community-based services.

Screening patients for the social determinants of health (SDOH) allows clinicians to identify those needs and tailor referral efforts. Due to constraints on clinic time and monetary resources, a simple screening tool incorporated into existing clinic workflow increases its usefulness and impact. Our free, nurse-led, mobile health clinic (MHC) needed an enhanced process or tool for screening patients for SDOH. The purpose of this quality-improvement project was to screen adult patients in the MHC for SDOH needs and to increase volunteer staff perceptions of their knowledge and confidence in referring patients to relevant community-based services. A screening process and tool was developed using guidelines from the Health Leads to identify patients' SDOH needs and related requests for assistance. The tool was introduced to and tested among volunteer staff through pretest/posttest surveys. Patients who visited the clinic were screened for the SDOH within the project period, and volunteer staff were surveyed about their perceptions of the screening tool. Sixty-four patients were screened for SDOH needs. Twenty-three percent reported food insecurity, 27% housing insecurity, 14% difficulty obtaining utilities, and 17% difficulty obtaining transportation; 28% requested assistance with their reported SDOH needs. Seventeen percent of patients reported two or more SDOH needs. At posttest, 100% of volunteer staff ( N = 9) indicated satisfaction with the SDOH screening questions, reported feeling knowledgeable about resources to use for patient referrals, and were confident in referring patients to needed resources. The screening tool aptly guided practice and was evaluated as "easy to use" for clinic patients and volunteer staff.

Descriptive Report of a Pharmacist-Directed Preconception Care Outreach Program in a Rural Maternity Care Desert.

Preconception care is the prevention and management of biomedical, behavioral, and social risk factors to improve pregnancy outcomes and overall health for reproductive-age patients. A community-based pharmacist-directed preconception care outreach program was developed for women ages 18-45 years living in a rural maternity care desert to help them identify potential health risks and provide them with the needed education, counseling, or referrals to address these risks. Supervised student pharmacists, pharmacy practice residents, and pharmacy faculty from a local University collaborated to provide this program at four community events in conjunction with a mobile health clinic. A summative evaluation was performed after the events concluded, modeled after the RE-AIM framework. One hundred and forty-one women were served by the outreach program. Nearly 98% reported at least one preconception health risk, and 45% reported a barrier preventing them from being able to have an appointment with a physician in the last year. The outreach program was feasible to implement and can be adapted to different settings. Pharmacist-directed outreach programs in rural communities may benefit patients who are not receiving or do not have access to such care in traditional healthcare settings.

Mobile health service demand, key morbidity magnitude, and trend at mountainous outreaches of Uttarakhand: A descriptive study

Background: Deploying mobile health vans (MHVs) to service disadvantaged, underserved mountainous hamlets across six districts of Uttarakhand on a “fixed day-fixed location” strategy was an effective initiative in the state in collaboration with Technology Information Forecasting and Assessment Council (TIFAC) and NRHM. Aims and Objectives: The aim of the study was to provide quality diagnostic and curative care through mobile health clinics at select mountainous outreaches of Uttarakhand state. Materials and Methods: A bimonthly mobile health services with fully equipped MHV sponsored by the directorate of science and TIFAC and assessment council and Government of Uttarakhand on a “fixed day, fixed time and fixed place” schedule were provided along pre-designated service locations. Results: A total of 77,688 beneficiaries received services through 902 camps spanning 13 quarters with an estimated 5976 and 89 beneficiaries per quarter per camp; 573 clients received ultrasound, 639 X-ray, 34 ECG, and 3543 other lab procedures. Quarterly demand for services was highest, 19.5% for gastrointestinal disorders, followed by 18.4% for musculoskeletal disorders, 13.8% for genitourinary system disorders, 11.8% for respiratory system disorders, and 8.5% for ENT and ocular disorders. The prevalent morbidity was predominantly acid peptic disease (15.5%), followed by osteoarthritis (13.3%) and low backache and renal stones (7.2% each). Conclusion: Integrating mobile health service delivery component with existing strategies adopted by public health system in primary health care is an operationally feasible and viable option to address ‘inaccessibility at disadvantaged mountainous outreach.

HIV Care Profiling and Delivery Status in the Mobile Health Clinics of eThekwini District in KwaZulu Natal, South Africa: A Descriptive Evaluation Study.

Mobile health clinics (MHCs) serve as an alternative HIV care delivery method for the HIV-burdened eThekwini district. This study aimed to describe and profile the HIV care services provided by the MHCs through process evaluation. A descriptive cross-sectional quantitative evaluation study was performed on 137 MHCs using total population sampling. An online data collection method using a validated 50-item researcher-developed instrument was administered to professional nurses who are MHC team leaders, following ethical approval from the local university and departments of health. Descriptive statistics were used to analyze the data. The results described that HIV care services are offered in open spaces (43%), community buildings (37%), solid built buildings called health posts (15%), vehicles (9%), and tents (2%) with no electricity (77%), water (55%), and sanitation (64%). Adults (97%) are the main recipients of HIV care in MHCs (90%) offering antiretroviral therapy (95%). Staff, monitoring, and retaining care challenges were noted, with good linkage (91%) and referral pathways (n = 123.90%). In conclusion, the standardization and prioritization of HIV care with specific contextual practice guidelines are vital.

Determinants of vaccine uptake in the elderly. Results from a mobile health clinic survey in Italy

Abstract Background Vaccination is one of the most effective public health tools for improving the quality of life of adults and reducing healthcare utilisation. Despite numerous vaccination campaigns targeting this population, vaccine uptake is generally low. The aim of this study was to investigate the main determinants of vaccine uptake in people aged 65 years and over. Methods A mobile health clinic initiative for health promotion has been set up in a railway wagon in the Veneto Region, Italy, in October 2022. Access was free and voluntary. Information was collected on age, gender, nationality, education level, BMI, as well as on smoking, physical activity, vegetable consumption and presence of hypertension, hypercholesterolemia and diabetes. Uptake of flu, zoster, pneumococcal and tetanus vaccines was reported by participants, as was any recommendation by healthcare professional. The effect of the variables on uptake was assessed using a multivariable logistic regression. Results A total of 638 participants were included, of whom 50.9% female. Mean age 72.6±6.1. Uptake of flu vaccine was 61.8%, while zoster 17.1%, pneumococcal 21.6% and tetanus 10.0%. The main factor for uptake was having received a recommendation from a healthcare professional (flu: AOR=4.29 95%CI 2.77-6.63; zoster: AOR=3.12, 95%CI 1.52-6.40; pneumococcal: AOR=5.11, 95%CI 2.50-10.44; tetanus: AOR=14.23, 95%CI 4.20-48,35). Flu vaccine uptake was associated with hypertension (AOR=1.77, 95%CI 1.03-3.06) and smoking (AOR=1.84, 95%CI 1.04-3.25). No association was found with other comorbidities, lifestyle or SES. Conclusions Population growth and increasing average life expectancy in Europe make vaccine uptake by older adults an integral part of a healthy lifestyle. Among factors involved in the decision whether or not to vaccinate, the recommendation from a healthcare provider remains the most important determinant, and this is more evident in the absence of specific campaigns, as in the case of tetanus. Key messages • Among possible determinants, recommendation from a healthcare provider is associated with a significantly higher uptake for flu, zoster, pneumococcal and tetanus vaccine in the 65+ population. • The magnitude of this effect is even greater in the absence of specific campaigns, as in the case of tetanus, when it increases uptake 14-fold.

The Effectiveness of a Mobile Health Clinic Delivering Mandatory and Elective Middle School Immunizations: A Descriptive Analysis.

Mobile health clinics serve a unique role in which they can offer affordable and adaptable care to the population they serve. The Edward Via College of Osteopathic Medicine (VCOM) mobile clinics began in 2020 as a partnership with the South Carolina Department of Health and Environmental Control (SCDHEC) to address the low vaccination rates that resulted from the COVID-19 pandemic. This study is a descriptive analysis that examines the number of vaccinations of tetanus, diphtheria, and pertussis (Tdap) and human papillomavirus (HPV) at different locations of administration including pediatrician offices, the novel VCOM mobile vaccination clinic, and the Spartanburg Health Department. The variables of interest and the study endpoints focused on Tdap and HPV vaccinations among students aged 11-12 years old in Spartanburg County according to the type of healthcare delivery location. From April to May of 2021, the VCOM mobile clinic was able to administer 279 Tdap vaccines and 189 HPV vaccines to students at local middle schools, which surpasses the number of vaccines administered at other sites from August 2020 to May 2021 when compared individually for both Tdap and HPV vaccinations. By assessing the total volume of vaccines administered by each group, the VCOM mobile clinic was established as an effective method of delivery and played a crucial role in the vaccination efforts of the Spartanburg community. Mobile medical units should be considered for similar efforts in providing care to resource-limited communities and those with limited access to care.

Physical accessibility, availability, financial affordability, and acceptability of mobile health clinics in remote areas of Saudi Arabia.

Access to primary healthcare (PHC) services is a significant concern, especially for those living in remote areas. Mobile health clinics (MHCs) are a model widely used to enhance access to healthcare in rural areas. In Saudi Arabia, the Ministry of Health has launched mobile clinics to facilitate access to PHC and increase access to healthcare. This study aims to assess the accessibility of MHCs in rural areas of Saudi Arabia measuring four dimensions of access from the patient's perspective: physical accessibility, availability, financial affordability, and acceptability. A quantitative cross-sectional survey in the form of an interviewer-administered questionnaire was performed on patients who attended mobile clinics between August and October 2020. All these people have been targeted to be interviewed as a nonprobability sample. Data was collected through a survey filled out by the interviewer. Five hundred participants were interviewed in nine mobile clinics in the nine cities of the Kingdom. The majority were men (82.4%) and from Makkah city (13.6%) and 94.2% of the participants were Saudi nationals. In total, 98.3% of the respondents were satisfied with the overall mobile clinic services and 11.4% of the participants had difficulties with the mobile clinics' work schedules. There was a positive correlation between access to mobile clinics and satisfaction. The mobile clinics in rural and remote areas in Saudi Arabia during the study period were accessible to the respondents and met patient satisfaction. Most participants accept the work schedule for mobile clinics. However, it requires further improvements to meet all access dimensions of the study.

Health care leaders’ perspectives on the business impact of mobile health clinics

BackgroundBy analyzing how health care leaders in the United States view mobile health programs and their impact on the organization’s bottom line, this study equips those who currently operate or plan to deploy mobile clinics with a business case framework. Our aim is to understand health care leaders’ perspectives about business-related incentives and disincentives for mobile healthcare.MethodsWe conducted 25 semi-structured key informant interviews with U.S. health care leaders to explore their views and experiences related to mobile health care. We used deductive and inductive thematic analysis to identify patterns in the data. An advisory group with expertise in mobile health, health management, and health care finance informed data collection and analysis.ResultsIn addition to improving health outcomes, mobile clinics can bolster business objectives of health care organizations including those related to budget, business strategy, organizational culture, and health equity. We created a conceptual framework that demonstrates how these factors, supported by community engagement and data, come together to form a business case for mobile health care.DiscussionOur study demonstrates that mobile clinics can contribute to health care organizations’ business goals by aligning with broader organizational strategies. The conceptual model provides a guide for aligning mobile clinics’ work with business priorities of organizations and funders.ConclusionsBy understanding how health care leaders reconcile the business pressures they face with opportunities to advance health equity using mobile clinics, we can better support the strategic and sustainable expansion of the mobile health sector.

Proportion of Reproductive Age Women Utilizing Mobile Maternal Health Services in Makueni County

Purpose: The aim of the study was to determine the proportion of reproductive age women utilizing mobile maternal health services in Makueni County.&#x0D; Methodology: An analytical cross-sectional study was carried out in Makueni County. Kibwezi East and Kaiti Sub-Counties were purposively selected. Ukia ward from Kaiti sub-county and Nzambani ward from Kibwezi East sub-county were randomly selected using folded pieces of paper. Both qualitative and quantitative data were collected. Questionnaires were the tools used for quantitative data while guides for key informant were used to collect data qualitatively. The study systematically sampled 367 women of reproductive age as primary respondents from households at a sampling interval of 5. Twelve Key Informant Interviewees were purposively selected to provide additional qualitative data which were community health extension workers and healthcare providers. The research instruments were pretested at Kilome Sub County before actual data collection. Analytical correctional statistical analysis was done using the Statistical Package for Social Sciences software version 20.0. Pie-charts, frequency tables and graphs were used to present data. Triangulation of data collected qualitatively with quantitative data was done and presented as direct quotes.&#x0D; Findings: The study found out that 40.6% of respondents utilized mobile maternal health services in Makueni County. The most common service sought was antenatal care. Distance from health facilities was the main reason for using mobile maternal health services. However, the main reason for non-use was preference for hospitals among respondents.&#x0D; Unique Contribution to Theory, Practice and Policy: These results would inform policy makers to craft interventions seeking to advance mobile maternal health services utilization. Community Health Volunteers should conduct house to house campaigns on availability of mobile maternal health clinics and the designated days on their respective regions to increase awareness among women of reproductive age.

"A Much Wider Field in Which to Operate": Early Black Women Physicians in Public Health.

In a profession shaped by Whiteness and masculinity, the few Black women physicians who earned medical degrees prior to the Second World War found some of their rare professional opportunities in public health. Though their choices were often constrained by racism and sexism, they embraced public health work as a means of carrying out their "mission" in marginalized communities and as a way of practicing medicine with a more expansive definition than treating individual patients or illnesses. Black women physicians shaped public health by creating unique programming to meet the needs of the communities they served, including mobile health clinics and community health weeks. The first Black women physicians who worked in public health in the nineteenth and early twentieth centuries applied the new tool of public health "vital" statistics to Black lives and questioned the limits of their utility when created by White practitioners with racial biases. In the 1930s, some Black women physicians began earning some of the first master's degrees in public health, just as the field was beginning to professionalize. Throughout the twentieth century, Black women physicians pioneered community health programming and, though born from exclusionary policies that limited where they could practice, experimented with alternative clinical spaces, even as the hospital and laboratory became the primary sites of medicine for White clinicians. By embracing public health, Black women physicians shaped the field and used it as a tool to address racial health disparities in the communities they served, acting on their belief that Black health could be improved, thereby contesting notions of biological inferiority.

Driving Sustainable Development: The Power of Vehicle-Based Services in Rural Sub-Saharan Africa

Vehicle-based services such as mobile health clinics can increase spatial accessibility in rural areas. In contrast to stationary infrastructure, vehicle-based services are flexible and can be less capital-intensive to initiate service supply. In particular, rural communities across sub-Saharan Africa experience insufficient access to essential public services necessary for sustainable human development. We consider vehicles as mobile service platforms capable of temporarily transporting service staff, goods, and functions necessary for service delivery spatially closer to rural demand locations. Despite these advantages, public authorities must perform a cost–benefit analysis before allocating resources to a vehicle-based service fleet. This paper analyzes which vehicle-based services beneficially influence the Sustainable Development Goals and quantify their potential for the sub-Saharah African region. Based on a criteria-based selection method, we parse 169 target formulations and extract a set of directly influential Sustainable Development Goals. The remaining goals are the starting point for a literature review to identify existing vehicle-based service concepts addressing the targets. Our evaluation reveals that vehicle-based services can enhance about 128 (76%) of all targets and 16 of the 17 Sustainable Development Goals. Half of these targets require the delivery of consumable goods, whereas 59 (35%) of the Sustainable Development Goal targets relate to the transportation of people, and 24 (14%) require access to a broader spectrum of functionality mounted on top of the vehicle, such as water pumps or refrigerators. In combination with publicly available data, we can identify the SDG for each African country with the greatest potential for a vehicle-based service intervention. Our approach enriches public project appraisals for systematical decision support between stationary and mobile infrastructure.

Learning from simulating with system dynamics in healthcare: evaluating closer care strategies for elderly patients

ABSTRACT This paper presents results from a simulation case study analyzing care strategies for elderly patients in a regional healthcare system (HCS) in Sweden. Three strategies to reduce emergency visits, hospitalisations, and stays were evaluated: care coordinators at emergency departments, mobile health clinics visiting fragile patients in their homes, and proactive primary care. Using system dynamics modelling and empirical data, the impact on the regional HCS was explored considering the reduced care demand and demographic changes. Subsequently, the impact on the population's health status was assessed. Combining strategies yielded the best outcome, but improving patients' health status may increase long-term care demand. The study emphasizes the importance of implementing these strategies to offer better care for elderly patients and reduce healthcare costs. Findings highlight the potential long-term effects of improving health status and the need for a comprehensive approach to address the evolving care demands of an ageing population.

An integer programming model for the deployment of mobile health clinics

Facility location and resource allocation play an essential role in the operational management of mobile health clinics (MHCs) as optimization of both can help medical service providers improve their service coverage under limited resources. In this paper, we consider the issue of maximizing the coverage of immunization services provided by MHCs in vulnerable communities such as school zones and census tracts. Since demand in communities overlaps with neighboring communities, this leads to the so-called mobile facility location with overlapped demand (MFL-OD). To capture the overlapped demand in different communities, we introduce a novel integer programming model with linear and bilinear constraints (BLCIP) and show that the BLCIP model is NP-hard. A polynomial-time approximation algorithm is proposed for the BLCIP, and the approximation ratio of the obtained solution is estimated. We implement the proposed model and approximation algorithm for a case study in the Houston Independent School District and its associated communities. Preliminary experiments demonstrate the efficacy of the proposed model and the efficiency of the proposed approximation method.

Comparison of an ID NOW COVID-19 Assay Used at the Point of Care to Laboratory-Based Nucleic Acid Amplification Tests.

The emergence of a novel coronavirus, namely, SARS-CoV-2, necessitated the use of rapid, accurate diagnostics to quickly diagnose COVID-19. This need has increased with the emergence of new variants and continued waves of COVID-19 cases. The ID NOW COVID-19 assay is a rapid nucleic acid amplification test (NAAT) that is used by hospitals, urgent care facilities, medical clinics, and public health laboratories for rapid molecular SARS-CoV-2 testing at the point of care. The District of Columbia Department of Forensic Sciences Public Health Laboratory Division (DC DFS PHL) implemented ID NOW COVID-19 testing in nontraditional laboratory settings, including a mobile testing unit, health clinic, and emergency department, to assist with rapid identification and isolation for populations at high risk of SARS-CoV-2 transmission in the District of Columbia. The DC DFS PHL provided these nontraditional laboratories with safety risk assessment, assay training, competency assessment, and quality control monitoring as parts of a comprehensive quality management system (QMS). We assessed the accuracy of the ID NOW COVID-19 assay when operated in the context of these trainings and systems. This was done by comparing results from 9,518 paired tests, and strong agreement (κ = 0.88, OPA = 98.3%) was found between the ID NOW COVID-19 assay and laboratory-based NAATs. These findings indicate that the ID NOW COVID-19 assay can be used to detect SARS-CoV-2 in nontraditional laboratory settings when used within the context of a comprehensive QMS.

The Ohio State University Guardant Shield Colorectal Cancer Screening Project.

TPS3626 Background: Asymptomatic screening is an effective method for detecting early cancers when prognosis strongly depends on stage at time of diagnosis. Unscreened individuals often have a basic understanding of the importance and availability of colorectal cancer (CRC) screening but have concerns regarding the collection method of the currently available stool-based options or the invasiveness of direct visualization options that deter test completion. We hypothesize that offering a blood-based CRC screening test during a routine healthcare visit can increase screening adherence, especially within hard-to-reach populations and those hesitant about completing CRC screening. Methods: The Ohio State University Guardant Shield Colorectal Cancer Screening Project (NCT05716477) is a prospective study in the United States designed to recruit individuals who are currently engaging with mobile health clinics and are not up to date with CRC screening, with the aim of improving health in hard-to-reach populations. The study’s primary objective is to evaluate the acceptance of a commercially available blood-based CRC screening test (Shield, Guardant Health, USA) in individuals aged 45-84, who have existing appointments with a mobile health clinic, and are not up to date with guideline recommended CRC screening. The study team screens for eligibility criteria before the appointment and reaches out to the individual to begin the informed consent process. Positive blood-based test results will be triaged to colonoscopy for further evaluation. A post-study survey will be administered to consented individuals aimed to collect data on CRC screening knowledge which will be correlated to patient demographics and uptake. Acceptance will be defined as those approached and with completed specimen collection. Progress: The study initiated on October 25, 2022, with the first patient enrolled on December 20, 2022. Enrollment is expected to continue with a target enrollment of 300 individuals. Clinical trial information: NCT05716477 .

Health Care Utilization among Homeless-Experienced Adults Who Were Seen by a Mobile Addiction Health Clinic in Boston, Massachusetts: A Quasi-Experimental Study

Background: Mobile health clinics improve access to care for marginalized individuals who are disengaged from the healthcare system. This study evaluated the association between a mobile addiction health clinic and health care utilization among people experiencing homelessness. Methods: Using Medicaid claims data, we evaluated adults who were seen by a mobile addiction health clinic in Boston, Massachusetts from 1/16/18–1/15/19 relative to a propensity score matched control cohort. We evaluated both cohorts from four years before to one year after the index visit date with the mobile clinic. The primary outcome was the number of outpatient visits; secondary outcomes were the number of hospitalizations and emergency department (ED) visits. We used Poisson regression to compare changes in outcomes from before to after the index date in a quasi-experimental design. Results: 138 adults were seen by the mobile clinic during the observation period; 29.7% were female, 16.7% were Black, 8.0% Hispanic, 68.1% White, and the mean age was 40.4 years. The mean number of mobile clinic encounters was 3.1. The yearly mean number of outpatient visits increased from 11.5 to 12.1 (p = 0.43; pdiff-in-diff = 0.15), the number of hospitalizations increased from 2.2 to 3.0 (p = 0.04; pdiff-in-diff = 0.87), and the number of ED visits increased from 5.4 to 6.5 (p = 0.04; pdiff-in-diff = 0.40). Conclusions: The mobile addiction health clinic was not associated with statistically significant changes in health care utilization in the first year. Further research in larger samples using a broader set of outcomes is needed to quantify the benefits of this innovative care delivery model.

Rural Prenatal Care by Nurse Practitioners: A Narrative Review.

Rural Canadian populations face many challenges due to their geographical isolation, including inaccessible and inequitable primary health care. Specifically, pregnant women are at risk of not receiving prenatal care (PNC) due to physical and social barriers. Inadequate PNC can have detrimental effects on both maternal and neonatal health outcomes. Nurse practitioners (NPs) are an essential group of alternative primary care providers who can provide specialized care, including PNC, to these underserved populations. The purpose of this narrative review was to identify existing NP-led rural PNC programs in other health care systems to support maternal and neonatal outcomes. A systematic search was performed to identify articles published between 2002 and 2022 on CINAHL (EBSCO host) and MEDLINE (OVID). Literature was excluded if (1) the context was based in urban centers; (2) the study focused on specialized obstetrical/gynecological-based care; or (3) the study was published in a language other than English. The literature was assessed and synthesized into a narrative review. The initial search identified 34 potentially relevant articles. Five broad themes were identified, including (1) barriers to care; (2) mobile health clinics; (3) collaborative or tiered models of care; (4) telemedicine; and (5) NPs as essential primary care providers. The introduction of a collaborative NP-led approach to rural Canadian settings has the potential to address barriers to PNC and provide efficient, equitable, and inclusive health care.

Community Wellness Bus: A Partner-Led Initiative to Improve Service Integration and Address Unmet Needs of Underserved Populations in Algoma District, Ontario.

Launched at the height of the COVID-19 pandemic, the Community Wellness Bus (CWB) is an evidence-based mobile health clinic that serves high-needs populations living in Sault Ste. Marie, ON. As an Algoma Ontario Health Team partner-led initiative that works to improve health and social service integration, the CWB program is an effective, collaborative approach to address the unmet needs of individuals who are underhoused or living with a mental illness and/or addictions in the community. This article aims to identify successes, challenges and opportunities for the expansion of this program to re-engage individuals with the local health system.

Smoking, betel quid chewing, and alcohol use among an indigenous primitive Tribal group in the Kerala State of India: Secondary analysis of a Tribal household survey

Background: In India, indigenous populations, known as Tribes, are among the poorest and most marginalized groups. We estimated the prevalence of smoking, alcohol use, and betel quid chewing and examined the association between gender and smoking, alcohol use, and betel quid chewing among Kattunayakan primitive Tribes who are categorized as a Particularly Vulnerable Tribal Group (PVTG) in the Kerala State of India.Methods: A secondary analysis of a sample of the Wayanad District Tribal Household survey comprising 388 Kattunayakan PVTG households selected through multistage cluster random sampling was undertaken. Binary logistic regression models were used to estimate an association between gender and smoking, alcohol use, and betel quid chewing in these Tribal households.Results: Mean age was 39.2 years (±15.1), more than three-fourths of the respondents were female (75.3%), and approximately 24% of the respondents reported smoking tobacco in past 12 months. A fivefold increased odds of smoking among males compared to smoking among females was observed (OR = 4.92; p < .01). More than 64% reported betel quid chewing. Prevalence of alcohol use was 16%, which significantly varied between males (49%) and females (5.1%; OR = 17.71; p < .01). Among tobacco smokers, 64.1% were involved in betel quid use. Among alcohol users, 62.9% were involved in betel quid use and more than 58% were smoking tobacco. Betel quid chewing was the most prevalent substance use.Conclusion: Single and dual substance use of the three commonest types were disproportionately high among this hard-to-reach Tribal population in the southern state of India, with some gender variations. Alcohol consumption was relatively low. However, the complex nature of substance use, compounded by inaccessible health services, poses a significant challenge to rethink and to reimagine innovative methods of providing mental health care services, for instance, mobile health clinics.