The coronavirus pandemic has upended existing approaches to health care and forced the medical community to reimagine health care delivery. Patient visits not related to COVID-19 have dramatically decreased as facilities implement infection control strategies and patients stay home for fear of contracting the virus. Beyond COVID-19, patients experience several barriers to accessing essential health care services at traditional brick-and-mortar institutions. Financial instability, housing insecurity, lack of transportation, and stigma often render people unable or unwilling to enter health care facilities. Many of these issues have only been exacerbated by the coronavirus.
As the health care industry confronts ongoing challenges, one potential solution to delivering care is to shift some services to a mobile health model. By flipping the idea that “the doctor will see you now” on its head, mobile health provides a solution that is customized to patients’ needs and is adaptable as those needs shift.
Experience in implementing a mobile addiction program has provided some insights about the feasibility and usefulness of a mobile approach, particularly for vulnerable and stigmatized populations. In 2018, the Kraft Center for Community Health launched the Community Care in Reach program, a partnership with Boston Health Care for the Homeless program, the Boston Public Health Commission’s AHOPE program, and the GE Foundation. The program seeks to increase access to care by bringing on-demand addiction services directly to populations at highest risk of near-term death.
The program deploys caregivers to overdose hot-spots in and around Boston, providing a combination of clinical and harm reduction services. Early results demonstrate the program’s feasibility and success in reducing barriers to care and serving as a point of entry for high-risk populations not currently engaged in care. Since 2018, the program has made nearly 10,000 contacts with people living with addiction and has been recognized as a best practice in Massachusetts; the state’s Harm Reduction Commission highlighted its early successes in its March 2019 report. The Massachusetts Department of Public Health recently awarded four contracts to expand Mobile Addiction Services in Boston, Worcester, Fall River/New Bedford, and Chicopee/Springfield that will serve individuals at high risk for overdose and other medical complications associated with substance use.
COVID-19 presents new challenges where strategic mobile health programming could offer solutions. As hospitals and health centers serve as the battlegrounds for this new viral war, patients are canceling non-emergency visits to avoid potential exposure. These cancellations pose new health risks. For instance, canceled well-child visits have reduced childhood vaccination rates, risking a resurgence of outbreaks of preventable childhood diseases. Cancer screenings and addiction services have seen similar declines since the onset of the pandemic. Mobile health programs can bring these important services out beyond the walls of a clinic and offer communities potentially safe spaces to have their health care needs met. Mobile vans licensed as satellite clinics of existing health care facilities can mobilize much of what can be offered during in-office visits: a private room complete with clinical space, sink, digital prescribing capabilities, and access to electronic health records. Careful planning, triaging of appropriateness for a mobile visit, and preparations to ensure adequate personal protective equipment, clear infection control protocols, and robust cleaning and sanitization can help ensure successful delivery of mobile care.
In addition to providing care spaces separate from clinics overburdened with COVID-19 cases, mobile health can also help overcome longstanding barriers that patients experience. Lack of transportation has long prevented some people from accessing health care, and increased unemployment, paired with a reduction in public transportation services, has left some more isolated than ever. Mobile vans can use a data-driven approach to increase accessibility by bringing the clinical office to patients. Investments in mobile health programming now will continue to benefit vulnerable populations by overcoming these barriers even as the risk of COVID-19 subsides, and can fill gaps where telemedicine is either not possible or not sufficient. Being on wheels also affords a level of programmatic flexibility that is particularly suited for this era of uncertainty, allowing for rapid response to emergent needs.
The coronavirus pandemic has challenged and strained health care systems. Now more than ever, solutions are needed that expand access and afford patients flexibility. Mobile health can help support coronavirus response efforts and overcome longstanding barriers to care that vulnerable populations continue to experience. It will be an essential tool for those instances requiring in-person care, yet not necessitating a hospital visit.
The patients are out there and ready to see us. Let’s meet that demand with creative and mobile approaches to care.
Dr. Elsie M. Taveras is executive director of the Kraft Center for Community Health at Massachusetts General Hospital and professor of pediatrics at Harvard Medical School. Craig Regis is program manager at the Kraft Center. Josh Kraft is president of the New England Patriots Foundation and board chairman of the Kraft Center.