1. Introduction to Mobile Health Vehicles
Types of Mobile Health Vehicles; Conceptual innovation in the field of healthcare is adding a new dimension. The introduction of the mobility concept improves and extends healthcare services beyond the four walls, into areas where healthcare facilities are not available, both by the government sector and non-governmental organizations. One of the mobile services utilized to reach areas where medical facilities are not available is mobile health vehicles. Mobile health vehicles improve accessibility, availability, and efficiency of medical care to underserved areas and populations. The primary purpose of mobile health vehicles is to provide accessible medical care services to rural populations or areas where stationary clinics or hospitals are unavailable. In addition to curative care, mobile health vehicles also provide preventive and diagnostic services, as well as specialized services to a limited extent. The curative, preventive, and early diagnosis services commonly provided through mobile health vehicles include prenatal care, postnatal care, family planning, general ailments, minor surgeries, geriatric problems, cancer screening, cervix cancer detection, oral cancer detection, and eye cataract detection. Some mobile health vehicles provide services like maternal and child health, which essentially offer all healthcare services to the mother and child from prenatal to six years of age. These healthcare services provided through mobile health vehicles are conducted free of cost or at a minimum affordable cost. Utilization of the latest technology, such as telemedicine and the internet, improves the efficiency and services provided in mobile health vehicles. All across the globe, innovative variations have emerged in mobile health vehicles. The concept includes specialized curative care services, diagnostic services, health awareness campaigns, mobile counseling, mobile blood banks, etc. These vehicles are designed to provide facilities as per the needs and in accordance with the health problems prevalent in respective communities.
It is possible to broadly classify mobile health vehicles into three categories: 1) static health camps, 2) mobile dispensaries, and 3) mobile hospitals. Static health camps are temporary centers organized at regular intervals, usually once a week, once a fortnight, or once a month, in which medical treatment and health education are provided in a selected rural area. Mobile dispensaries are the latest innovations, covering a wider area than static health camps. However, only medical services are provided in mobile dispensaries. Auto rickshaws, jeeps, and other vehicles may be converted into mobile dispensaries. Mobile hospitals are health units on wheels, equipped with necessary facilities for diagnosis, treatment, and minor operations of an outpatient nature. The larger bus or van models are usually used to create mobile hospitals. Mobile hospitals and dispensaries have gained wide popularity in some countries in Asia for providing medical coverage to rural areas that are not feasible to be covered by regular health institutions.
2. Primary Care Units – Types of Mobile Health Vehicles
A primary care unit is a basic component of mobile health vehicles that serve to address general health problems common in the specific community where they operate. Should any type of health problem occur more frequently in one community rather than another, this information can be used to design various parts of the vehicle that are specific to that community. Primary care units are capable of providing routine care in the form of check-ups or physical examinations. Patients may also opt to receive routine care to prevent health problems rather than to treat them. Thus, the vehicle can offer routine care and check-ups both with and without the element of diagnosis and treatment, to accommodate patients who face barriers to accessing conventional healthcare facilities. These units are also designed to provide varied care addressing as wide a range of health problems as possible. This is because not all individuals have the same needs. Some may be healthy and only seeking to remain healthy, whereas others may suffer worse health conditions and require specialized services; therefore, the mobile units must offer general health services with the ability to do ‘something more.’ However, the extensive scope of primary care units also poses the highest risk of resource constraints at this level of operation because increased service provision naturally comes with increased staff time and other inputs. Moreover, should the choice of service be up to patients, the matter of having differing levels of care for different individuals arises, as patients who are capable of choosing can influence the resources assigned to them. The biggest limitation is in cases of patients trying to access care or avail themselves of a specific service for which the vehicle is not sufficiently prepared. For instance, if the ambulance is not designed to deliver a baby, then where this service is needed, people may not be able to choose it if they are aware that delivering a baby in an ambulance might be dangerous. Moreover, patients may not consider it reliable if they know this is not a part or specialty of the ambulance vehicle. Concurrency, the ability of the vehicle to go directly to the community, is an advantage over the patient traveling a distance to reach more specialized care. Recommendations therefore include combining one ambulatory emergency service with some routine care. The advantage of combining a routine care service such as a primary care unit with the basic emergency service is obvious: while reaching all of the community, it can offer a variety of indispensable routine curative and preventive services. The community is also aware of the availability of these services as an additional benefit. Thus, patients see that in case of any danger or extreme condition, the vehicle can at the minimum attend to their problems to a certain extent before they reach a hospital for further specialized treatment. Moreover, if the situation is not really serious, recipients need not go to the hospital and merely receive care from this vehicle. Home healthcare is an additional facility. Overall, the outlook will be a package deal of care acceptance or demand. There is the additional possibility to attract the population by offering those services that are not available in hospitals and larger health facilities.
2.1. Description and Features Types of Mobile Health Vehicles
Large and well-equipped units designed for various types of health services flow to provide primary healthcare using methods of family medicine, as well as secondary and specialized assistance in remote hard-to-reach areas, and in areas of increased patient biological risk. To help the main functional areas in the vehicle, there are two offices for receiving a medical clinic, as well as laboratories with separate cabins for storing veterinary laboratory equipment. Primary care units, which are used for educational purposes, carry out primary care, provide medical advice and assistance, conduct rehabilitative treatment of the population, and implement preventive measures for a healthy lifestyle. They provide primary functional diagnostics, carry out healthy child delivery, healthy child registration, and palpation X-ray examination. The mobile clinics are equipped with appliances, office equipment, instruments, and workstations. The oversized vehicle is 77 feet 10 inches in length, 8 feet wide, and 13 feet 6 inches high. Office cabins are suitable for practicing blood drawing, ultrasounds, and phlebotomy. There is a virtual reality lab and a separate patient education room, along with a consultation room. The long body could provide more space in general. Two private doctor’s offices accommodate the lab for blood samples and have substantial restrooms for the doctor and nurse. The rear workstation has a door and is used for patient registration and to connect the hydraulic leveler for the patient’s optional observation deck use.
2.2. Benefits and Limitations Types of Mobile Health Vehicles
Much has been written about the advantages of mobile primary care units, and yet difficulties in going beyond expounding the virtues of the attractions of the single units are considerable. Admittedly, one of the most important effects of the units is to make it possible for medical services to be provided to citizens who might otherwise not receive them. People in some rural areas increased their use of health care services after a mobile unit visited the area in which they lived. Similarly, a report indicated that a percentage of the people who attended the mobile unit used the unit as their only source of medical services; a significant percentage used it as a second source of services. The very fact that the units travel from place to place should make it possible for older and ill persons—those who do not drive or who cannot depend upon a husband or friend to take them elsewhere—to see a physician and receive medical attention. The effect of the mobile unit includes enhanced access to medical services and, ex hypothesi, some amelioration in individual and community health.
The fact that a large number of visits to physicians are made by people already in an advanced stage of illness and often in need of hospital care makes it difficult to ignore the possibility that some of the patients who visited the mobile unit would have waited at home until they became sicker and less able to pursue vigorously the activities of daily living. This would be an even more likely event were those concerned elderly citizens, some of whom live alone, or poor persons who preferred not to ask their families for the funds necessary to pay for doctors’ bills. It is also quite possible that the easy access to reduced-cost care, including preventive care, provided by the mobile unit has afforded some people what we might think of as freedom from apprehension and worry. A mother of a young child might not have taken her child to a crowded emergency-type situation for a relatively minor illness had not the mother known that another source of health care was available. While some people attended the mobile unit because they were unable to pay or preferred not to pay the fees charged by private physicians, transportation costs probably included, relatively few people led to the mobile unit by public health workers appeared to be indifferent to the fees averaging a certain amount per medical visit. By significantly reducing the strain of the newly developed emergency system.
3. Dental Care Units Types of Mobile Health Vehicles
Types of Mobile Health Vehicles; Dental care units are specialized mobile health vehicles that offer an array of dental services to those who may lack access to oral care. Some of those services usually include cleanings, oral examinations, and cavity restoration. The primary goal for these units is to provide more access to those in the community and educate others about the importance of oral health care. This can also be called preventative dentistry to stop any current dental caries from getting worse. Traditional big rig truck trailers can be converted into mobile dental units that provide a whole list of dental services to help communities get basic care. Providing these vehicles will offer services to many people in low-income and affordable housing, including children, the elderly, and working middle-class families. More units in many states are being built because, as you go to the schools and see children, many times the children have a little brother or sister who is not in school yet and they need services as well, and the parents request it and sign their child up for a time and day to be seen. We all know that the dental clinic is costly for people who can barely put food on the table, gas in the car, or keep the air conditioning or heater on to be warm or cool. Despite everyone’s best efforts, some remain out of reach, such as the homebound or long-term care populations.
Mobile dental units utilize large trucks onto which specially designed dental offices are built, and they are stocked with the essential dental equipment necessary to safely provide dental care. These units are more self-contained than the portable dental equipment previously described, enabling them to provide a wider range of dental services in more locations. There are several benefits to using this sort of equipment. Although not as efficient or cost-effective as a traditional dental office, mobile dental units can provide certain populations greater access to current oral health services and maximize preventative oral health education. However, there are limitations to the services these teams can provide. For example, emergencies must be referred to a traditional dental office, and follow-up for treatment or examinations is difficult. Mobile dental units can provide basic dental care, such as cleanings, restorations, and extractions, in medically underserved communities. However, complex services such as extensive prosthetics, orthodontic treatment, and surgery may not be able to be performed. Thus, considering all these factors, the mobile dental unit is a part of teledentistry, but only one part, and it may not provide complete oral health care to all the population’s needs.
3.1. Description and Features Types of Mobile Health Vehicles
3.1.1. Dental care units travel into the community to serve a variety of populations who experience barriers to traditional dental care. The equipment carried onboard to diagnose and treat oral diseases and maintain oral health includes electric dental and examination chairs. Dental handpieces and sterilization equipment, x-ray and digital radiograph units are available onboard to enhance the diagnostic process. Mobile dental unit layout and design are based on the dental services to be provided and the preference and skill of the equipment providers. Attention to the layout must include the movement of dental staff, patient flow, and the comfort of the patient.
The design of the dental unit and dental clinic space can provide dental care for adults and children, including persons with special health care needs. Technological capabilities onboard the unit include digital radiography and registration to assist in diagnostic and preventive care. The onboard digital radiography provides for a reduction in radiation exposure for the patient and image quality to enhance the ability of the dental staff to accurately diagnose disease processes in the oral cavity. The dental staffing team includes experienced clinical dental staff, such as a dentist and a hygienist and/or expanded function dental assistant, skilled with multiple treatment modalities. Patient enrollment and staffing patterns must consider the volume of patients to be served and the patients’ needs. It is advised that the successful provision of dental services onsite requires adequate clinical dental staffing, appropriate equipment, and a valid and current radiographic permit and certification allowing for transport and use of dental x-ray and digital radiographic equipment. These dental staff must be comfortable working with all types of parents, guardians, and dental patients. The clinical dental staff provides diagnostic, preventive, surgical, and restorative care. This care includes oral hygiene, dental sealants, fluoride varnish, scaling and root planing, extractions, root canal, and filling care. Referrals to other dentists, health care providers, or treatment facilities in the community are made if the patient’s dental needs cannot be met onboard the dental unit. Staff provides oral health education and promotion to children, adults, and parents who are seeking the services of the unit, in addition to community outreach and education. The dental team provides the resources to develop and maintain school-based oral health treatment services and preventive care onsite or at the mobile dental unit in an after-hours setting. Staff has the ability to address special considerations or needs of an important subset of the dental patient population. The dental staff provides objective, evidence-based documentation of treatment services delivered, treatment received, and treatment presented or referred. Patient diagnosis is in compliance with code.
3.2. Benefits and Limitations Types of Mobile Health Vehicles
The aim of the study was to discuss mobile dental care units as an essential tool to address community oral health problems. Mobile health units are essential for healthcare delivery, as they are also crucial for community oral health. The community benefits of dental care units include providing greater access to dental care, reducing location-based disparities in dental care utilization. The dental care gaps in a particular region can be reduced by mobile dental van visits. Mobile dental vans can be utilized to help spread public health education and advice to patients about oral hygiene, general health, dental diseases, care, and treatments before they arise, preventing deterioration of the individual’s health. Restricted service offers: The dental mobile van can be used as a primary health care center for treatment, consultation, and investigation purposes. Dental care units are not licensed to perform advanced preventive surgical and treatment services over time, such as full mouth extraction. The dental unit provides a service that limits the number of people who come for treatment, leaving the patient continuity of care halfway through the service. Equipment maintenance: It may lack the latest technology and maintenance, and the risk of equipment wear can affect the service. The response lies in the thorough consideration and development of oral health programs that address health determinants such as sugar intake, poor hygiene awareness, smoking, tobacco chewing, and alcoholism.
4. Mental Health Units Types of Mobile Health Vehicles
One facet of the diverse landscape of mobile health vehicles offers mental health services. Mental health units are service-dedicated mobiles that cater to various psychological and emotional needs in a community. Services generally include counseling or therapy, offering a listening ear and advice on the short-term management of common psychological problems. Crisis intervention may include counseling and, in cases of assessed high risk, collaboration with hospital and emergency services.
A mobile mental health clinic provides real mental health care at street level. It treats clients as people with problems rather than pathology, is non-objectifying, and is designed to engage and help those who would otherwise avoid the mental health system. Unit staff include psychologists, social workers, and psychiatric specialist medical officers. Mental health units offer an opportunity for whole-person collaborative practice. Practical evaluations indicate that most clients can be trained to manage a full range of everyday primary health care and social needs and report increased confidence and a renewal of hope for the future after visiting the mobile health clinic. It is easier to direct them to day centers and other services in some areas because the intervention effectively links mobile health clinic staff to associated agency staff in outreach work in the same precinct.
A flexible, though non-coercive approach enables the mobile health clinic to be positioned as a sensitive filter into the mental health system where appropriate. This is one way that a practical philosophical activity to address social exclusion through social connection and empowerment, combined with the most secure affordable care, might be focused. Results regarding referral to specialized services are few because staff time and small, poorly maintained, and equipped clinic spaces allow only a few brief contact sessions per precinct sortie. In the challenge for the federal government to generate demand, it is likely that some intricate matters related and referrals may be higher than other agencies. The range is large and depends on community attitudes, client tolerance of potential compromise, and clinic capacity to address the relevant locality. In small and informal qualitative assessments, some people were as likely as others to seek a positive therapeutic relationship with the mental health team, if no emergency assistance was proposed. Limitations include community readiness, which has value in patient databases from accessing other referral forms to assess the appeal of the station of the street. Staffing constraints and safety also limit the benefits of those companies that employ full-time equivalent psychology units with regular staff.
4.1. Description and Features Types of Mobile Health Vehicles
Mental health units are community-based mobile health service programs. Several kinds of mobile health vehicles are available, including general practice buses, mobile health clinics, and wellness, mammography, dental, and various other clinics. The features of units in this publication are based on those of mental health units funded by or in partnership with the federal or state governments. They are full-size vehicles – either buses or recreational vehicles (RVs) – measuring between 26 and 45 feet for seven or more people, depending on the design. The vehicles are climate-controlled, brightly colored, and have paintings that welcome clients, convey a sense of calm, and show a welcoming environment. Inside, they are divided into multiple spaces to provide mental health services in team meetings, individual or two-chair therapy sessions, triage, and records areas. They also offer restrooms if they are going to be parked at a site for an extended time.
The mobile health vehicles are staffed by multidisciplinary teams of health care professionals, including therapists, psychiatrists, nurse practitioners, and peer support specialists. They also use a variety of technologies to provide telehealth services and administrative support, as well as educational presentations. These vehicles are staffed by a driver or drivers, administrative staff, and therapists during their time of operation. Behavioral health providers focus on the treatment and support of people with mental health and/or substance use issues. The presence of a staff therapist in the units enables an expedited warm hand-off to such professionals in an integrated physical/mental health setting. Medical services are generally not provided on the units. The units are staffed by mobile health professionals to deal with program management, administrative, and customer service needs. They are rounded out with administrative and finance support staff. Each mobile health team member is trained in trauma-informed care and to be sensitive around mental health issues. Medical providers have expertise in medication-assisted withdrawal treatment, treatment of mental health disorders, and treatment of co-occurring mental health and substance use issues. They have the ability to refer clients to inpatient or other available resources in their area. These vehicles comply with national and local laws related to confidentiality.
4.2. Benefits and Limitations Types of Mobile Health Vehicles
While transportation itself may be a significant barrier to receiving much-needed community-based psychological care, mobile health vehicles work to bring the services to the individual. There are different types of mobile health vehicles that serve people in the community who may have otherwise been forgotten or left out of the service system. Primary care-based mobile units are large, ambulatory vehicles that may have multiple sub-specialties. For example, a large van may be staffed with a primary care physician, a pediatrician, an optometrist, counselors, and a dentist. Smaller units may also serve as harm prevention systems such as needle exchange programs that offer vital services like counseling and the provision of a drug that can stop an opioid overdose. Mental Health Crisis Care Mobiles often operate within large municipal areas and serve the less resourced homeless and other individuals suffering from mental illnesses. Psychiatric mobile response units are generally centered around university hospitals and serve individuals in crisis or with suspected physical illness superimposed on a mental health condition. In short, regardless of the services offered, mobile health vehicles are typically thought to offer benefits such as reducing patient stigma and increasing patient visits to see professionals upon referral.
Individuals served by mobile mental health units share some of the same benefits as those served by mobile doctors; however, there are certain unique challenges associated with running mobile mental health services. By bringing services to the site of reputation (a food pantry, a tent village, or local jail, for example), mental health care reaches individuals in familiar surroundings, leading to a reduction in the stigma of attending therapy or the disruption of the therapeutic relationship a physical move to a brick-and-mortar clinic may entail. The mobile unit also brings the provider to collaborators who make the initial referral. Thus, someone working at the food pantry can help the client understand why it is beneficial to engage with a mental health professional. Limitations of modern behavioral health mobile units have yet to be resolved but need to be studied. For example, staff often either admit immediately or encourage or necessitate the individual’s acceptance into some ongoing mental health system often provided in a facility. In fact, certain crises are handled by having clients sign a document that they will follow up with a psychiatrist, therapy, social services, etc., before the individual leaves the mobile unit. Another limitation is the lack of data validating whether these units provide effective care in the most cost-effective manner. Evaluation is not consistent across mental health mobile vehicles, and few publish results; further, other locations cannot effectively duplicate care because of the lack of detail provided. Other limitations include the lack of minimum training required of a counselor to work on the mobile unit and even using a structured framework to intervene with clients. Universal boundaries about who will be seen and what can be provided on the vehicle from location to location are not standardized. Considering these points, further detail is required to shed light on effective measures for treatment, and we should identify the differences between mental health and primary care mobile vehicles.
5. Specialized Medical Units
Specialized medical units are especially equipped for selected medical fields. For example, mobile cardiological units provide a variety of cardiological services, such as echocardiography, electrocardiography, cardiac catheterization, single-photon emission computed tomography scanning, radioisotope therapy, angiography, and blood tests. Similarly, units will be developed for immunology, oncology, pediatrics, and veterinary services. Specialized units will also expand the range of people receiving medical attention because some patients may be unable or less likely to drive long distances to see a consultant. Some patients living a significant distance from a static facility may find that medical intervention, service, and advisory explanations can reduce the severity and resultant costs of the intervention required. Unfortunately, specialized units have the potential to be stifled by the ongoing limits and labors of the workforce, which is often the case. Staff working in specialized units tend to need to be trained to a higher level and attract a better rate of pay, which consequently reduces the funds available for training new staff.
The first type of vehicle to be developed for deployment was the specialized medical unit. For a mobile health vehicle to be designated as a specialized medical unit, the vehicle had to carry a mix of high-technology medical devices and equipment to enable a variety of diagnostic services to be conducted in the vehicle. For example, the first unit developed for the mobile health service carried a 1.5 Tesla MRI, a Philips 20 Slice CT, a Siemens SPECT, an ACIST cardiac catheterization unit, and a mammography machine. Research and data obtained from mobile health caravans revealed that the specialized units provided valuable diagnostic assessments by the consultant to the GP and were widely referred to. For the targeted conditions, the units attracted a broader demographic of referred patients. People attempted to avoid metropolitan hospital-centric systems where possible, and for those with private health insurance, it could avoid a 12-month wait for an appointment in the private system. Consequently, patients were often using their own funds for the diagnostic plus consultation. Medical tourists also find the services attractively priced. The response from health staff treating the patients once the MRI report is forwarded was that very advanced disease could be seen, and medical radiation oncology was noted on the MRI in a number of treated situations, with 41 patients seen in two days for the one referring consultant. These diagnosed cancer patients, who arranged their own expensive travel, are attending the nearest health facility on the dedicated mobile health service for their treatment whenever the onsite oncologist calls in. The state-based cancer control agencies for five of the diseases have also issued a first-call priority to the mobile service for treatment.
5.1. Description and Features Types of Mobile Health Vehicles
Various medical vehicles have specific designs and different uses. Specialized medical units meet specific healthcare needs of the relevant community. The basic feature of specialized medical units is that they utilize specialized equipment inside vehicles to provide necessary or complementary medical services on the spot. For example, mobile imaging medical units need to install ultrasonic imaging systems or mobile X-ray systems or mobile CT systems in the vehicles. This equipment can carry out imaging diagnosis for various parts of the patient. Mobile physical examination vehicles need to have a full set of auxiliary examination equipment, such as eye examination tonometers, ophthalmoscopes, and other equipment. Moreover, the design of the comprehensive coach can be transformed into a multi-person consultation room with a partition. One side is the doctor’s area, and the other side is the inspection area for patients.
Specialist medical vehicles can carry out not only primary medical treatment for patients but also professional targeted health assessments. Based on the vehicles’ configurations, such units are usually equipped with some specialist equipment and also have the physical capacity to conduct some complementary tests as a backup for some of their services should complications arise. Furthermore, specialist vehicles are now equipped with telemedicine capability, which allows for a high level of specialist service provision, allowing the specialist to be ‘tele-present’ during the session. The vehicle’s staff need to include specialists with the relevant qualifications, and sometimes also a mobile phlebotomist for the blood test. Some units also need to employ triage specialists because the first consultation is not directly with the medical specialist but with the triage staff. The triage specialist will be able to send some potential patients directly to the consultation with the specialist in another room of the vehicle, based only on the blood count results, without waiting for the radiological or other exams. Obviously, all medical staff will have continuous training in patient management protocols, safety standards, quality control, and clinical biochemistry, as well as being trained to use electronic databases for data entry.
5.2. Benefits and Limitations Types of Mobile Health Vehicles
Specialized Medical Units. In Canada, specialized medical units in mobile health include mobile mammography screening units, vision screening units, mobile TB testing units, and oral health care units delivering services to children, the elderly, and other vulnerable populations in various communities. In the United States, specialized service mobile units provide women’s health care, cancer care, psychiatric care, and dental care across the country. In Thailand, an ophthalmology truck is used to deliver cataract surgery, optical, and eye check-up services. In Botswana, a cervical cancer screening unit delivers visual examination of the cervix with acetic acid, sexually transmitted infection and HIV testing, and treatment. Researchers have observed that participation in mobile or transportable vision screening units has increased convenience and access to these services among the elderly, children, and marginalized populations. For example, patients typically note that VA assessment is a major reason to visit a mobile unit, as VA testing is often required for driving licenses, insurance purposes, and suitcases.
Despite these advantages, there are potential limitations to utilizing mobile medical units for some specialized services. For example, women who are found to have a suspicious lesion during a mobile mammogram visit are encouraged to visit a fixed site for timely follow-up studies and maybe even a biopsy to confirm the diagnosis. Unfortunately, the adherence rates of women who have been advised to complete additional fixed-site diagnostic tests after having a screening mammogram on a mobile unit are often lower than those who are receiving a mobile exam. Patients must have on-site diagnostic services and an appropriate specialist to perform further assessment to provide a same-day service. In addition, not all specialized services units operate in every locality or along a whole route. Staffing specialized services mobile units requires training and may preclude the ability of the mobile health venue operator to adjust the route and timetable at will.
