Mobile Health Vehicles Types

Mobile health vehicles

1. Introduction to Mobile Health Vehicles

Mobile health vehicles, which usually refer to motor vehicles designed for medical services, are “moving medical centers” that bring medical services close to patients, whatever setting they may be in. In the visited area alone, some countries have constructed more than ten different “vehicles.” These different types of mobile vehicles are used to better accommodate and reach a population of varying needs and socioeconomic backgrounds. Since the second half of the 20th century, the field of motor vehicles not only covers the whole society but also pertains to many different fields. In an era of attention-seeking, such vehicles are invariably resourceful and well advertised with images and various detachable flyers. By fits and starts, the number of health vehicles per patient had marginally increased between 1986 and 2014. Further back in 1985, there was a tentative wait for treatment after a three-month imposed wait of sixty miles flight to reach more remote, virtually untouched areas, especially if no plan was to prospect some time off on leisure. Also, mainly the companies owning them had no real opportunity for larger growth due to escalating competition. It goes without saying the country founded abroad already had five vehicles different in size and function, of which health only now owned two.

The necessity to make healthcare more accessible is growing. The health vehicles offer medical treatment, health promotion, and prevention of diseases. It is necessary to educate the part of the population about health issues and diseases; most are treatable if diagnosed timeously. Vehicles have set out to help overcome disparities. The “Health Vehicle” can be defined as a moveable health workstation, which provides services in communities and schools. Water and electricity supply is frequently provided by consultations, where health vehicles are connected and technologically equipped to access online software. Stationary cubicles within the vehicle allow counseling, precautionary advice, basic observation, and other essential health services. Procedures like optometry (through an attached room), urine dipsticks, and blood sample tests can also be done in consultation, with the latter faxed to a participating general practitioner. Staff is equipped with cellular telephones and ambulances; there is a direct link to centers. Various ambulance services are used in other provinces for emergency transportation and backup support. The “Health Vehicle” also promotes the primary health care program through outreach programs, as one of its eight strategies by the government. Mobile clinics operate in a wider range, e.g., corporate, non-governmental, regional, and national initiatives.

2. Primary Care Mobile Units

Primary care mobile units deliver typical outpatient or offsite health services. For daily operation, these vehicles are equipped with standard examination rooms, sinks for handwashing and sterilization with or without supplies such as gloves and gowns, as well as medical equipment and supplies for visual examination and diagnostic procedures, often including an electrocardiogram machine and medical laboratory. Some units offer additional basic office services such as patient examination and charting space, clinician office space, and space for patient registration or other front desk functions. It is important to consider that the services rendered by this category of mobile health vehicles do not provide emergency medical services, which are considered to be urgent. Specialized clinics are designed to replicate the services provided in specific hospital or health center satellite clinics.

The services offered via the primary care mobile units target prevention of disease, ambulatory care for chronic disease state management including check-ups, and minor acute care treatments. Primary care mobile units are capable of referring patients seen on the mobile health vehicle for follow-up care, whereby patients would be evaluated by a physician or advanced practice clinician in a traditional healthcare facility. That said, services offered on primary care mobile health vehicles may in some instances include chronic disease management programs, which are a more versatile way of providing community services and population health management outside of the vehicle. Mobile health vehicles providing preventive health services, mostly vaccination-related services, are given drinking water and restrooms. Primary care mobile units are the primary driver of preventive health services to medically underserved populations while also filling the role of supporting chronic disease care and healthy lifestyle promotion.

2.1. Description and Features

These mobile primary care units are designed either as large buses or as semi-trailers hauled by a truck tractor for operational mobility. Layouts are customized to meet specific requirements and may be designed to accommodate dental care, mental healthcare, and other services as part of an integrated model of primary care. Medical equipment, supplies, and other devices used in the provision of medical services are stowed securely, yet readily accessible. Impact to staff, patients, and equipment from operating is minimized while requiring a minimum of additional setup steps. Typically, a mobile unit is equipped with one or two private exam/treatment rooms, a laboratory draw station, an intake and waiting area, a staff work area, and a bathroom. Some units have ADA-compliant features and lifts. A growing number of mobile units are equipped with telemedicine/telehealth technology, and some are networked with an electronic health records system.

The layout is designed to maximize the flow of people getting on and off the mobile unit during the clinic and to enhance the efficiency of the medical provider practitioners interacting with their patients. In many cases, the neurological process of quickly assessing whether patients are emergency or routine can occur on the outside and in the waiting area of the mobile unit before the patient ever steps onto the mobile unit. Where possible, evaluating this process and engaging the design team in this step of space planning becomes an important cost-saving strategy for the provider organization. The current trend in mobile unit space layout and design is to strengthen this customer service experience between the mobile unit healthcare provider and the patient. It is not unusual for the first step of the process to be to perform an upfront community health assessment as soon as the population being served is defined. Compliance with state health department and local health department regulations and requirements are operational criteria for mobile units as well. In contrast, a multi-purpose mobile primary care vehicle is usually employed where the location of the medical clinic fluctuates or where special, live, or one-moment-in-time medical services are offered.

2.2. Benefits and Limitations

In the United States, the use of mobile units aims to ameliorate some of the access issues for underserved populations. Research suggests that mobile health units can provide screenings and follow-up care to improve health outcomes via targeted interventions. People may avoid care for a myriad of reasons, such as mistrust of the medical system, personal reasons, lack of transportation, or a dearth of free time. Mobile health care units serve to address these obstacles. High coverage in preventive services could lead to potential savings in the long term. Limited staffing options may hamper the utility of these units as a long-term replacement for standard primary care services. In order to be operationally viable, a model for continuous staffing of the operations would need to be developed. While mobile units and other similar models operate in many areas around the country, they would not be feasible for regular health care delivery in the general population because of their prohibitive cost. Even with grant opportunities, charity care funding, and negotiated transportation and maintenance costs, the mobile health vehicle operations may not be able to achieve fiscal solvency. Beyond that, mobile health programs involve more than just finding staff; the units themselves require maintenance, and because they are operated on state-by-state regulations, the vehicles essentially need to be self-contained clinics, able to meet each individual state’s permitting process for clinic facilities. It requires a significant time investment in planning to develop the vehicle, and a significant amount of upkeep on the part of the grant writer to secure funds. In addition to this, systematic follow-ups such as making patient referrals, pairing incentives for follow-up, and giving patients the necessary materials for follow-up are essential for maintaining a population health-based program. Additionally, considerable effort is needed to get local residents, who often have never engaged with the medical system, to come out to the mobile health units.

3. Specialized Health Service Vehicles

Beyond primary care, mobile health vehicles are often seen that offer services specifically focused on a need, also known as specialized health service vehicles. Some specialized vehicles focus on providing therapeutic or treatment services, such as medical, nursing, and lab services. Mobile health vans often focus on providing services such as oral health, mental health, medical services, maternal care, vaccines, blood screening, etc. Different types of specialized health service vehicles also have different features. For example, dental vans carry x-ray equipment, dental chairs, and the instruments a dentist needs to assess and care for teeth. In addition to treating the sick and ailing, the vision of these programs is to encourage people’s active interest in issues of health as well as to spread awareness for preventive measures and the promotion of sound health in the population.

Specialized health services on a van organize their regular visits to a predetermined area or a specific location. Areas covered are normally those that are deficient in medical facilities or not receiving health services, especially for preventive and promotional health care. Patients to be seen are also identified and informed through announcements or hoardings placed at strategic locations to ensure proper inflow of patients. For field visits, the crew usually moves on cycles or two-wheelers to reach the population residing in the underserved areas. Dentists may work from a van or in conjunction with specialists in the pre-identified health facility such as a school, Anganwadi, P.H.C., sub-center, or slum for outreach activities, preferably the same day of the field visit. In some cases, they can also make on-site house visits, medical camps, etc. Staffing a mobile unit requires a mix of administrative and technical skills. It is the responsibility of the social worker to coordinate with different departments to reach the concerned authorities, ensuring synergy instead of duplication of work since the population in the pastoral areas would be similar.

3.1. Dental Care Units

Specialized health services can be provided to underserved populations from within health service vehicles with specialized equipment. For example, dental care units are fully equipped with dental chairs and various dental instruments, including X-ray devices, compressors, and sterilization equipment, providing general dentistry services and emergency dental treatment as well as diagnostic dental services and care such as periodontal, endodontic, and prosthetic services and oral surgical diagnoses. Some dental service vehicles are equipped with one dental chair and a local X-ray device, while other vehicles may have several dental chairs and a panoramic X-ray device, a gliding camera, and laser appliances, providing advanced dental care, including dental implant surgery. However, these dental treatment services must be combined with education and prevention-based dentistry, and then oral health measures will be effectively taken with such dental services.

Preventive dental services and oral health education and promotion are important approaches to reducing disparities in oral health among the underserved. Smaller and lighter portable mobile dental care units have been produced or developed using vans or trailers to transport dental equipment and dental units to schools, public facilities, as well as self-help areas and other places to conduct dental check-ups, dental education, and preventive dental treatment, providing oral care services to convenient areas and people. This can provide health care services whenever and wherever the need arises and expand access to oral health and dental service resources, improving the oral health of all. In many cases, people travel to lecture halls, parks, and other areas where dental health promotional vehicles stop and receive oral health educational lectures, demonstrations, and videos to promote oral health education. A mobile oral health exhibition organized by schools, regional dental associations, and city government was held in a municipal car park. The purpose was to better promote oral health care knowledge. Posters on various themes of oral health care were posted on the walls to allow visitors to watch the exhibition and learn about oral health care. Educational brochures were distributed to visitors and informational lectures were held on subsequent days.

3.2. Mammography Vans

Mammography vans are mobile units specifically designed for breast cancer screening. Mobile mammography vans are fully equipped with digital mammography machines and specialized technologists to get the best high-quality films necessary for early detection of breast cancer. The patient area within the vehicle consists of a reception/check-in area, dressing/changing room, mammography unit, and patient consultation room. Women can expect the same high-quality mammogram at mobile mammography sites as they do at any fixed clinic sites from caring staff.

As part of comprehensive cancer centers or academic hospitals, most support staff at those sites are knowledgeable in dealing with cancer treatments and diagnoses, as well as discomfort caused by the mammogram x-ray background information. Mobile mammography van screening programs can improve mammography screening rates targeting rural and/or low-income areas, especially in America. Women who do not have a personal health advisor and may have difficulties with the required steps of the mammography screening process may be identified, recruited, and scheduled for mammography at the mobile unit through the use of outreach programs that educate women on the importance of regular screening for the early detection of breast cancer. Outreach strategies for screening may involve a variety of collaborations between the mobile program and local organizations, such as health care providers, faith-based organizations, and public health, as well as collaborative efforts with local mass media. In addition to obtaining mammograms, patients typically receive patient navigation and referral resources through partnerships established with local partners. Technology may allow counseling to be done through the screen.

Two obvious logistical issues to consider include procuring and routing the vans on a regular basis. This may affect participation rates as well as staff feelings of job satisfaction. In some cases, there are patients’ concerns for privacy, especially when waiting or entering the van. Rural communities are more likely to utilize mobile mammography units if no breast imaging centers are available in their area. A case study of a successful mobile mammography van program would examine the geographic location; why it was chosen and how public health professionals assessed the need for such a service would be instrumental in demonstrating the benefits of such a program. In summary, the mobile mammography van has been very successful. The goal is to provide early breast cancer detection services in areas that are underserved.

4. Emergency Response Vehicles

Mobile health emergency response vehicles are a critical component of the reconfigured health system. These vehicles provide the capability to rapidly deploy time-critical, advanced life support-type medical services and to provide preventative, primary care, and immediate post-disaster care to victims. These mobile health services can function at various problem points in the community, providing services that vary from stabilization and triage at the incident location to a one-stop facility that treats, documents, and shelters affected individuals and their families. Health returned to the community is one of the main components for a disrupted community to mobilize and begin the knowledge growth activities that will be needed to respond to a world that has changed.

These health vehicles are mobile command centers. They are stripped to the chassis of a used vehicle and customized. The vehicle must also be able to adapt human resources for various cultural groups and psychosocial problems they will face, and also to link to a host of other emergency teams in the areas of fire, police, and public health. Some are equipped with specialized feeding, mental health treatment, counseling services, and transportation capabilities. All of these systems are supported with advanced telemedical and communications technologies. In the destruction from a disaster, these mobile medical response vehicles can also be tailored to gain access as relief and food distribution points to communities that remain isolated by the disaster impact, save lives, and reduce human suffering. It is the one single new equipment that can fulfill the most critical current operational need of the health service system in a disaster. These vehicles usually function as mobile treatment areas. The staff are trained to care for the injured as well as protect themselves from disaster toxins. All of these systems work together to improve patient outcomes. In the event of a pandemic, conceptually these vehicles can also function as decontamination centers.

Today, local and large hospitals use transit buses to help build relationships with patients suffering mental health problems to reinforce the health community network concept, with the additional feature of providing mobile mental health services particularly designed for safety and a more individualized response during a mental health or selective disaster trauma event. It is common for health systems to want to have command centers for every 150,000 to 350,000 persons. All mobile medical services vehicles are required to operate without external supply of electricity, water, communication, data, heating, or pharmacies for a number of days, given that their concentration point can be physically cut off from its support network by a severe disaster event to extend and update the components of the locally based health system that represented. This is the only part mobile medical emergency service vehicle in the world that some systems use to extend the health services network onto the waters. Emergency health response vehicles are one of the best documented mobile medical response concepts in the world, with a successful implementation of these two types in numerous local health systems and in disaster environments.

5. Technology-Enhanced Mobile Health Units

Innovation has played an essential role in healthcare transformation. After years of focusing on outpatient care, large health systems increasingly recognize the need to move services into communities. The healthcare field is rediscovering the promise and potential of mobile health units. Technology-enhanced mobile health units help meet clinical and social needs by using telemedicine, electronic health records, and mobile diagnostic technologies to improve access to and quality of healthcare services. The common thread across most of these technologies is a focus on expanding geographic or functional access to the care provided within the mobile health unit, supporting care coordination and collaboration, and increasing patient engagement.

The use of telehealth in mobile settings has changed the way that underserved patients interact with healthcare providers. Further, telehealth technologies such as video connections have the potential to increase the scope of services that can be provided through a mobile health clinic and expand the range of settings from which clinicians can provide services. However, there are challenges with using and maintaining equipment in mobile settings and with training staff to use the telehealth tool. Settings where healthcare services are provided need to be carefully screened to ensure patient privacy and data security. Additional trends may include the ability to better predict and more quickly respond to emerging public health crises or population health trends. In sum, the future of technology in mobile health approaches is seen as increasing personalization of care, while increasing the impact and efficiency of healthcare delivery.

Examples

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