Types of Mobile Health Vehicles

1. Introduction to Mobile Health Vehicles

Mobile health vehicles offer a new way to deliver health care to the people who need it. These vehicles come in different sizes and setups, but generally, they are staffed by medical personnel who provide clinical or supportive services directly to the public. Some pre-registered clients are given appointments on the mobile, but many units also open for walk-in business and provide services with no appointment necessary. The vehicles typically visit the same locations repeatedly to expand their reach to the intended target populations. There are many reasons people seek out the mobile for their care. In many cases, health care professionals choose to work on a mobile because they are selecting to work with a particular population or in a certain neighborhood. This could be because the patients are underinsured or uninsured, because they are migrant workers or refugees, or because of some other connection they professionally or personally have with a community. The United States is now seeing a need for the service that mobiles provide for a couple of different reasons. There is the expanding number of underinsured or uninsured people, but our population is also becoming much more flexible, and being able to adapt to the times is important. The health needs of communities are not constant. In response to the changing demographics of many communities, mobile health units can be easily modified to accommodate the increase in certain types of health services as well as easily integrated into community disaster response. With the advancement of technology, health care has been radically changed and is being more readily delivered outside of the doctor’s office. Telemedicine gives doctors and other health practitioners the ability to provide care by phone, email, and over the internet.

2. Primary Care Mobile Health Vehicles

One of the most common uses of a mobile health vehicle is to provide primary care services. Many areas of the United States are underserved by primary care physicians. Mobile primary care health facilities provide patients with access to routine care, and with some facilities, treatment for acute problems without an appointment. Many different types of mobile health vehicles can be utilized to provide a variety of services. Primary care mobile health vehicles are vehicles that are customized to provide routine healthcare services to a uniform population or a low-income population in a designated area or at specific outreach sites. There are several different types of primary health mobile health vehicles employed in the United States, but they generally can be categorized as a ‘Clinic on Wheels’ or a ‘Mobile Health Van.’ A ‘Clinic on Wheels’ is a larger-sized, specially designed vehicle that serves as a fully equipped doctor or dentist’s office in motion. ‘Mobile Health Vans’ are different from the Clinic on Wheels. They often work alongside providing health education but are largely used for preventative care, targeting children, adolescents, and adults.

Since their inception, the service environment and healthcare centers are growing increasingly determined to provide care instead of sick care. The primary care clinic on wheels is part of the well-established healthcare center model that is looking to focus on helping with illness prevention. This type of preventative care clinic offers services such as physicals, immunizations, vaccinations, women’s health exams, pregnancy tests, electrocardiograms, dental screenings, and many others. In the United States, the importance of promoting healthy habits to reduce the risk of developing overt chronic illness is recognized. This is just one way to help with primary care in the Bitterroot country. Even preventative medicine can become necessary for some Bitterroot country inhabitants. It can also be quite difficult to get to the doctor’s office if mobility is compromised in some way. Another benefit shared by all types of mobile health vehicles is that the practice is done in an environment the patient is more familiar with. The patient might be shy about coming to a hospital or clinic, but if they are at work, home, or school, they are more likely to call on a mobile health service.

2.1. Clinic on Wheels

Diabetes, arthritis, and chronic diseases are common in the United States. People with these and other conditions often visit their doctor or other healthcare provider for medical advice and care. When people do not visit their provider, their condition can become worse, which will lead to more healthcare bills. About 20 years ago, the rural part of the state of South Carolina had higher hospital and doctors’ office bills compared to the state’s urban communities. The South Carolina rural communities had more chronic disease diagnoses, and many could not afford their medications. In response, the state’s main research university and hospital developed a “Doctor’s Office on Wheels” that traveled to the low-income rural and urban communities. Many people received needed healthcare and disease information that improved their health. This “Doctor’s Office on Wheels” idea expanded nationwide, and today’s clinics are named “Clinic on Wheels”.

A “Clinic on Wheels” is a typical doctor’s office that is driven or towed to a convenient location for people to receive medical services. A mobile clinic is staffed by healthcare professionals, such as a nurse, social worker, physical therapist, and/or doctor or nurse practitioner. The traveling clinics are equipped with medical equipment and supplies that may include scales, blood pressure cuffs, digital cameras, laptop computers, and other devices. At the Clinic on Wheels, people can receive a health screening such as a tuberculosis test, cholesterol check, hearing and sight testing, and glucose testing. Some clinics offer vaccinations and microchip implanting for pets. In addition to the screenings, people may meet with a healthcare provider to talk about a health problem or request a prescription for a health issue. Some readings may be too high, such as a cholesterol check. In a Clinic on Wheels, a healthcare provider can work with someone to explain what the high reading may mean in terms of future health problems, which lifestyle is most helpful in lowering the high reading, and alternative medication options.

2.2. Mobile Health Vans

Mobile health vehicles can range in size and model. They can be fully equipped health facilities on wheels, with laboratory services powered by generators and containing multiple private examination spaces for patients. Less maximalist versions can eliminate the examination rooms in favor of an open-clinic setup or an educational center on wheels. These vehicles are known to build community trust, efficiently park in locations that are in desperate need of health services, bring care to patients at locations or times they would not attempt to visit a clinic in person, and accomplish specific values such as skin cancer screening events at highly attended events or for a defined range of sports and age groups that tend to draw a fan population with insufficient primary care follow-up. Mobile health vehicles are also early adopters of healthcare services to new immigrant or migrant populations, as building a brick-and-mortar center for care before utilization rates are tested is not advisable.

Mobile health vehicles also represent face-to-face connections with healthcare in areas that generate the best metric of healthcare – the patient encounter. It is very easy to measure a user/patient visit. Programs can also count repeat visits and longitudinal engagement as measures of success in understanding problems that require more trust building because of the difficulty of directly comparing a woman who has never visited an environment to start her contraception to a woman who has visited six times to an environment to start contraception. Vehicle programs can estimate the urgency or need for immediate intervention in their area based on the pace of user increase or the steadiness of patient utilization. Most programs will tie the services offered in the vehicle to major health concerns of a specific neighborhood because we suspect that bringing those services into a neighborhood will identify new healthcare complaints not previously identified about which to then develop a set of field health services. Primarily, the form of medical, social, and advocacy services offered from a van is determined by local staff that know their neighbors and their needs. Nationally available suggestions of appropriate mobile health vehicle services are scarce, as they should be.

3. Specialized Mobile Health Vehicles

While some mobile health vehicles offer general care to a wide variety of populations and communities, there are also specialized mobile health vehicles. Specialized mobile health vehicles offer specific health services delivered by medical providers with expertise in a specific discipline. They come with specialized diagnostic and treatment equipment, and they have providers who are trained in the specific needs of the populations who receive their care. Specialized vehicles can address the specific health concerns of a particular community and can be particularly helpful when transportation, equipment, or medical provider needs are unusually challenging.

Notable specialized vehicles include dental mobile units or buses that provide preventive and therapeutic dental care to children up to at least 18 years of age. These programs address specific oral health disparities and provide for a broad scope of services. Mammography vans can screen for early signs of breast cancer using specialized radiography equipment and radiologists to read the film. These programs primarily serve uninsured or underinsured women younger than 65 years, especially women who are from lower socioeconomic groups, geographically isolated areas, or ethnic minority populations in which access to breast cancer screening is limited. Mobile mammography makes it easier for women to have mammograms by bringing breast cancer screening services directly to their workplace or community. Early detection and intervention are both important elements because they can lead to cancer being confirmed and diagnosed at an earlier, more curable stage. In turn, women with small localized cancers may be able to avoid chemotherapy, mastectomy, and radiation and will have a better prognosis than women with similar tumors for whom detection was delayed. Women also value the convenience of mobile mammography—including the vehicle’s short visit and the knowledge that results will be mailed to them—and the comfort of undergoing a mammogram within a small, well-designed mobile van rather than a large hospital or clinic setting.

3.1. Dental Mobile Units

Dental mobile units are dental clinics on wheels or “trailers” that serve populations that lack adequate transportation. Dental mobile units are furnished with two dental operatories (two patient chairs in each operatory), digital X-ray machines, a panoramic machine, dental supplies, and computers for the doctors to enter treatment notes. Today’s mobile units are owned and operated by for-profit and non-profit organizations such as health departments, community and rural health centers, and hospital systems.

The program aims to change the way the country views oral health by emphasizing prevention and education. It is the first model program in the nation. The program indicators show progress toward the program’s goals by reaching targeted demographics within identified metropolitan statistical areas, achieving school sign-ups, providing needed oral health services, and impacting the chosen schools’ data. These dental mobile units provide preventive and restorative dental services, including sealants and fillings. Staff of these units in some cases educate patients on proper hygiene. Both children and adults receive dental care. The Dental Program – Health Department in Crete owns and operates two fully equipped mobile units that provide preventive dental services to schools and communities within the area. The units provide sealants, cleanings, and fluoride treatments; patients are referred to local dentists if they need further restorative dental care.

3.2. Mammography Vans

A pivotal development of the past 25 years has been the initiation of mammography screening programs for early detection of breast cancer. The intent is to detect tumors in the asymptomatic phase, and before they palpate, so that they can be discovered when they are smaller, less aggressive, and easier to treat. As the popularity of these programs has grown, so has the challenge of getting women to participate. Thousands of mobile and portable mammography vehicles travel throughout the country, taking mammography services to the public. Their designs offer comfortable and private settings for these often vulnerable patients as they journey from worksite to shopping mall, senior center to house of worship. As more programs develop, the number and diversity of patients that each serves varies substantially. From urban areas where the mobile mammography unit is used primarily for the “never screened,” to rural areas where the majority of those who are screened do so at the mobile unit, the capabilities and strengths of each program vary. Programs for mobile mammography vehicles share the overriding goal of ensuring that the advantages of the tests are made available to all women, and of meeting women where they are so that transportation, child care, and cost are not barriers to screening. Among the many women who rarely or never present for healthcare, those who attend or are invited to mammographic screening are more likely than even women who seek medical care to get mammograms. Once these mobile units are implemented, they require increased maintenance scheduling and budgeting to assure that radiologic services are provided effectively to the target populations. Staff also receive mammography-specific training when the units are first initiated and on some regular basis every two to three years. There has also been considerable outreach to employer groups, community organizations, and local health departments. Overall, these programs have proven successful in providing access to screening services for a group of women who are otherwise unlikely to be screened for early detection of breast cancer. Mammography vehicles are a viable, affordable, image-guided health technology that appears to be increasing the detection of breast cancers by mammography screening in women who are rarely or never screened. Some mobile units serve both insured and uninsured, but even those that serve only a particular at-risk group or other similarly underserved are always fully equipped with services for circumventing barriers to mammography such as insurance plans requiring physician orders, limited office hours, and appointments for care that interfere with work schedules. Particular challenges that needed to be addressed include where to park or locate the unit so that women’s discomfort, agency turf issues, and competitors’ claims of unfair marketing practices do not become community barriers to the units providing service. Retention of the staff required the germination of an advisory committee to revise the guidelines for eligibility of services as well as to formulate specific standards for outside funding stream participation. Development of the vehicles also meant aggressive turnover in program leadership until experience could be gained in accommodating other existing image-guided health technologies in selected primary care settings.

4. Technology-Equipped Mobile Health Vehicles

Mobile health vehicles equipped with technology are improving the ways positive health outcomes are achieved. In addition to clinicians onboard, these vehicles have telemedicine capabilities that link them with specialists at healthcare facilities. This links patients to exams or specialist consultations previously unavailable at these healthcare sites without a visit to the hospital. Technology-equipped mobile clinics can have electronic health records, allowing easy transcription and data sharing when patients are transferred to area hospitals. In addition to examining and treating patients, providers are given tools to perform diagnostic workups on the mobile health clinic. Once results are collected, necessary care plans are included as part of the patient visit. This mnemonic also alerts emergency medicine physicians to any workup that was done and the results of that test or X-ray. These advanced mobile health vehicles can also have applications to use during the monitoring of a disaster to aid in the emergency service response.

One of the key benefits of using these advanced mobile health clinics to provide care is patient flow through the system and data analysis. Visit data can be collected at the point of care and semi-real-time reports with visits and data about visits can be uploaded into the local public health monitoring system on a daily basis. This is in contrast to years past when local public health received aggregate emergency room data daily, which did not include demographic data and varied per hospital in the data reported with each visit. Telemedicine technology-based mobile clinics allow real-time doctor-to-doctor consults. During a health emergency, states often require data to be collected from healthcare visits. When agencies use technology-equipped vehicles, the data collection is part of the daily patient process. Appropriate, accurate data is collected at the time an individual seeks care. The investment in technology-equipped mobile health vehicles increases efficiency and effectiveness, providing health services while streamlining the data collection process. Telemedicine technology and diagnostic tools are enabled by a telecommunications infrastructure. It is the key that makes all of the sophisticated mobile health vehicles work. In the past, agencies delivered one or two types of health services using a mobile vehicle. Moving forward, agencies may need to use their mobile health resources to deliver preventive, primary, specialty, point-of-care, and telemedicine services. Mobile vehicles come equipped with today’s best technologies to meet population health needs.

This section highlights the challenges and future trends in mobile health vehicles. While there are numerous outreach and health care programs in operation, many recession-era vehicles face financial challenges, including a lack of dedicated funding, aging vehicles and equipment, and limited staff and resources. Programs that provide health care tend to replicate local health care and utilize volunteers, part-time staff, and existing health care providers. The influence of public perception and lack of knowledge of mobile health vehicles remain a sharp barrier, similar to standard mobile health care and services, especially when discussing high-profile programs. Restrictions and regulations from disease liability and vaccine preferences continue to drive operational costs. Programs must be attentive to their specific situation and community to derive a solution, not just a best practice. The vision is for you to utilize mobile health services to their full potential, whether you are integrating them into an existing core program or creating a standalone, thriving service. Future trends within the industry are also discussed.