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"HEALTH CLINICS"
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Mobile clinics: Medical service strategy for disaster healthcare response operation
Purpose: Disrupted healthcare facilities due to disasters leave the affected communities without access to sufficient health care. This study proposed the use of mobile health clinics to address the issues faced by medical service providers during disaster response.Design/methodology/approach: A mobile health clinic a mobile facility that performs health care services from a stationary location. The model was developed as a healthcare response strategy, considering demand uncertainties due to the nature of the disaster. Therefore, this study objective is to simultaneously generate the mobile health clinic route and schedule and determine how each mobile health clinic covers patient demands within a pre-specified time horizon. The stochastic model is presented because the disaster's impact varies according to its scale.Findings: An investigation of the medical shelter effect in locations with high number of displaced people and the routing of mobile clinics for several shelter locations with a small number of people show that a hybrid strategy comprising a medical shelter and a mobile health clinic is the best option. Mobile health clinics can serve many locations within an appropriate walking distance. It can also route them to other locations when the time constraint allows. With a high number of people located in a shelter, building a medical shelter provides a better service.Originality/value: This study proposed mobile health clinics as a medical service strategy during disaster response to address the challenges faced by communities during a disaster response. The idea of mobile health clinics (MHC) is to improve communities’ access to healthcare services.
Journal Article
The need for sexual health clinics, their future role, and contribution to public health
Specialised sexual health clinics (SHCs) play an important role in addressing the staggering rates of STIs seen in many high-income nations. Despite increasing healthcare coverage in the US and nationalised health care in some countries, there is a continued need for SHCs to meet the needs of patients and the community, especially for high-priority populations: those at high risk of STI acquisition and/or groups historically marginalised and underserved in the traditional healthcare system. We need to mobilise resources to support a stronger clinical infrastructure in specialised SHCs. This review describes the importance of SHCs, their future role, and some of the innovative programs housed within SHCs in the US, Australia, and the Netherlands to address both STI and HIV prevention for the populations they serve.
Journal Article
PrEP Knowledge and Attitudes Among Adults Attending Public Health Clinics in Southern Arizona
HIV pre-exposure prophylaxis (PrEP) is underutilized among Hispanics, women, and low-income individuals. To better understand PrEP barriers in this population, questionnaires were administered to 500 patients attending public health clinics in southern Arizona which provide family planning and sexually transmitted infections care. Sixty-three percent believed that they had no risk of HIV infection. When asked “Before today, did you know that there was a pill that can prevent HIV infection?” 80% of persons answered no. Among women, 88% answered no to this question. As expected, individuals with a higher perceived HIV risk (OR 1.76) or one HIV risk factor (OR 5.85) had a higher probability of knowledge. Among survey participants 87% would take a daily pill, 91% would visit a health-care provider every 3 months, and 92% would have laboratory testing every 3 months. Fifty-four percent would not be afraid or embarrassed if friends or family knew they were taking PrEP. Seventy-two percent would take PrEP despite temporary nausea. Sixty-two percent would pay ≥ $40 every 3 months for PrEP. Lack of knowledge, rather than patient attitudes, is the more important barrier to wider utilization of PrEP among individuals, especially women, attending public health clinics in Southern Arizona. Future efforts need to focus on education and access to PrEP in underserved populations including women and Hispanics.
Journal Article
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.
Journal Article
Appropriateness of diabetic down-referral letters to primary healthcare clinics in the uMgungundlovu district municipality of KwaZulu-Natal
The majority of patients living with diabetes mellitus (PLWD) are diagnosed and managed at primary care level. Much research has focused on diabetes mellitus, its complications and the need for earlier referral from primary to higher levels of health care. Little research, however, has focused on down-referrals of PLWD.
This study assessed whether down-referral letters of PLWD to primary healthcare clinics (PHCs) and community healthcare centres (CHCs) in the uMgungundlovu district of KwaZulu-Natal contained adequate information, were legible, had a follow-up plan and whether national guidelines were adhered to. Questionnaires were distributed to nurses and doctors working in PHCs and CHCs to assess their opinions of appropriateness of down-referrals of PLWD during November and December 2019.
A total of 127 referral letters and 55 questionnaires were assessed. Referral letter assessment revealed that 81.1% of PLWD had no glucose control and 85% had no renal function documented. Diabetic complications were recorded infrequently (3.94%). One-third (33.6%) of the PLWD over the age of 40 years were not down-referred on a statin while 6.3% were on a medication combination that was not in accordance with the South African Essential Medicines List. A significant number of referral letters had no clear management plan other than medications listed (96.1%), with no follow-up appointments documented (95.3%). Less than two-thirds (60%) of letters were easily legible. The most common down-referrals were from district hospitals (98.43%). Questionnaire respondents agreed that referral letters generally contained information on the patient's medication and comorbidities but rarely contained information regarding glucose control or complications of diabetes, among which foot and eye complications were significantly omitted.
Analysis of down-referral letters identified many omissions, in both clinical and biochemical data, that are needed by clinicians working at both CHCs and PHCs to optimally manage PLWD. It is imperative that findings of studies like this be used in developing intervention strategies targeting this level of diabetes care.
Journal Article
Is Time Spent on Prior Authorizations Associated With Approval?
Advanced practice providers increasingly assume responsibility for prior authorizations (PAs). We hypothesized that the time burden of PAs will be correlated with increased approval. We collected several variables (ie, type, method, time spent, use of peer to peer, and outcome) for all PAs completed by a departmental nurse practitioner in 1 region. Chi-square tests and 2 sample t tests were used to assess significance. There was no significant association between the method of request, the number of attempts, and the time spent to approved PA. Further research is needed to determine ways to decrease the time and opportunity cost associated with PAs.
•Advanced practice providers assume the responsibility for prior authorization.•Prior authorizations can be tedious and burdensome to navigate.•Prior authorizations have inconsistent intended outcomes for patients and providers.•Fewer prior authorizations can improve practice efficiency and patient outcomes.
Journal Article
Telehealth Care for Mothers and Infants to Improve the Continuum of Care: Protocol for a Quasi-Experimental Study
Ensuring an appropriate continuum of care in maternal, newborn, and child health, as well as providing nutrition care, is challenging in remote areas. To make care accessible for mothers and infants, we developed a telehealth care system called Portable Health Clinic for Maternal, Newborn, and Child Health.
Our study will examine the telehealth care system's effectiveness in improving women's and infants' care uptake and detecting their health problems.
A quasi-experimental study will be conducted in rural Bangladesh. Villages will be allocated to the intervention and control areas. Pregnant women (≥16 gestational weeks) will participate together with their infants and will be followed up 1 year after delivery or birth. The intervention will include regular health checkups via the Portable Health Clinic telehealth care system, which is equipped with a series of sensors and an information system that can triage participants' health levels based on the results of their checkups. Women and infants will receive care 4 times during the antenatal period, thrice during the postnatal period, and twice during the motherhood and childhood periods. The outcomes will be participants' health checkup coverage, gestational and neonatal complication rates, complementary feeding rates, and health-seeking behaviors. We will use a multilevel logistic regression and a generalized estimating equation to evaluate the intervention's effectiveness.
Recruitment began in June 2020. As of June 2022, we have consented 295 mothers in the study. Data collection is expected to conclude in June 2024.
Our new trial will show the effectiveness and extent of using a telehealth care system to ensure an appropriate continuum of care in maternal, newborn, and child health (from the antenatal period to the motherhood and childhood periods) and improve women's and infants' health status.
ISRCTN Registry ISRCTN44966621; https://www.isrctn.com/ISRCTN44966621.
DERR1-10.2196/41586.
Journal Article
The scope and impact of mobile health clinics in the United States: a literature review
As the U.S. healthcare system transforms its care delivery model to increase healthcare accessibility and improve health outcomes, it is undergoing changes in the context of ever-increasing chronic disease burdens and healthcare costs. Many illnesses disproportionately affect certain populations, due to disparities in healthcare access and social determinants of health. These disparities represent a key area to target in order to better our nation’s overall health and decrease healthcare expenditures. It is thus imperative for policymakers and health professionals to develop innovative interventions that sustainably manage chronic diseases, promote preventative health, and improve outcomes among communities disenfranchised from traditional healthcare as well as among the general population.
This article examines the available literature on Mobile Health Clinics (MHCs) and the role that they currently play in the U.S. healthcare system. Based on a search in the PubMed database and data from the online collaborative research network of mobile clinics
MobileHealthMap.org
, the authors evaluated 51 articles with evidence on the strengths and weaknesses of the mobile health sector in the United States. Current literature supports that MHCs are successful in reaching vulnerable populations, by delivering services directly at the curbside in communities of need and flexibly adapting their services based on the changing needs of the target community. As a link between clinical and community settings, MHCs address both medical and social determinants of health, tackling health issues on a community-wide level. Furthermore, evidence suggest that MHCs produce significant cost savings and represent a cost-effective care delivery model that improves health outcomes in underserved groups. Even though MHCs can fulfill many goals and mandates in alignment with our national priorities and have the potential to help combat some of the largest healthcare challenges of this era, there are limitations and challenges to this healthcare delivery model that must be addressed and overcome before they can be more broadly integrated into our healthcare system.
Journal Article
