Taking Care to the Streets

Saskatoon, Saskatchewan, and Seminole County, FL, have both developed mobile health outreach programs to improve access to primary medical care. There are some differences, but many of the services are the same, and so is the goal of each program: to enhance the healthcare available to isolated residents.

The Saskatoon “Health Bus” and the Seminole County mobile health unit both take healthcare providers out into their communities to provide primary care to people who are face barriers to care geographically, financially, culturally and socially.

The idea for the Saskatoon Health Bus began in 2007 after two local ambulance company representatives saw a successful “mobile community medicine” program in the U.K. that used nurse practitioners and paramedics. After the concept was introduced to the Saskatchewan Ministry of Health, the Health Bus began operation in 2008 as a partnership between community health, primary healthcare and emergency medical services.

The Health Bus was created to support many different populations that traditionally had troubles accessing services: First Nations, Métis, children, the elderly, immigrants, refugees, people with chronic diseases and those with no primary care physician. Primary care is available for anything from sniffles to minor emergencies. Referrals can be made for further care. As proof of the concept, in its first few years of operation, patients seen were 48% aboriginal, 25% under 16, and 9% newcomers to the area.

The Health Bus is unique among other mobile healthcare programs in Canada because it pairs a paramedic and a nurse practitioner. Both can assess and treat patients, while the nurse practitioner can also diagnose common illnesses, prescribe certain medications, order lab tests and refer people to specialists. This is also a model that’s growing in the U.S. in places like Mesa, AZ, and Anaheim, CA.

It is staffed seven days a week, following a set schedule in each of seven locations around Saskatoon’s core. Walk-ups are welcomed, and no appointments are taken. Locations can change based on local needs. For example, in 2014 the bus began stopping to provide services at The Lighthouse Supported Living facility in downtown Saskatoon. This facility houses some of the most vulnerable citizens in the city, many of whom might be reluctant to use walk-in clinics. They include the working poor, people with intellectual disabilities and people with addictions.

In 2012–13 nearly 6,000 patients visited the bus. The majority (57%) were adults age 20–60, and 35% were children and youth. Officials hope that weekly visits by the bus will reduce strain on the EMS system. They also hope to reduce hospital ED visits for minor medical needs that can be taken care of on the bus.

The stated program vision of the Health Bus project is the “creation of a mobile primary health center as a venue to generate health equity and close the disparity gap of those who are geographically, socially, economically and/or culturally isolated.” The teams of paramedics and nurse practitioners, who focus on community care:

• Establish networks with social agencies;
• Work within the communities to help residents reach their highest level of wellness;
• Work with community members to promote and maintain health, wellness and injury prevention;
• Advocate for their patients to facilitate access to additional services and resources;
• Identify challenges and solutions to development of a better, more integrated healthcare system.

Healthcare teams provide:

• Enhanced access to treatment;
• Information and education;
• Health promotion;
• Follow-up care;
• Referrals to further care;
• Referrals to social services.

Types of care routinely include wellness checks for blood pressure and blood sugar, diagnosis and treatment of common illnesses and minor injuries, STD testing, pregnancy testing, condom distribution, suturing and subsequent removal, wound care and management of chronic conditions.

The bus is described as a leader in community medicine because it allows paramedics to expand the use of their skills to help care for people in nonemergent situations. The Saskatchewan Ministry of Health has produced a fact sheet that contains providers’ “Stories from the Health Bus.” For an excerpt, see the sidebar.

Evidence of the bus’ success was shown by the program winning the 2012 Award for Innovation in Family Health from the Canadian Public Health Association and Amgen. The program was also recognized as a “Promising Practice” by the Health Council of Canada.

Seminole County Mobile Health Unit

Some 4,000 miles to the southeast in Central Florida, the Seminole County Health Department recently launched its own mobile health unit after a collaboration with local stakeholders revealed a need to focus on chronic disease prevention. The mobile health unit was created to extend this focus into impoverished communities countywide, where even basic healthcare can be lacking.

Operating two days a week initially, the unit stops in Altamonte Springs on Wednesday afternoons and Sanford on Thursday mornings. The driver triages the patients who arrive, a nurse practitioner consults with patients, and a navigator helps with insurance questions and signups.

Nearly 75,000 residents in Seminole County under the age of 65 are uninsured. That is about 20% of the county’s total population. The unit allows the homeless, uninsured, underinsured and residents with chronic diseases to access the following health services:

• Family planning;
• Birth control;
• Pregnancy testing;
• Annual physicals;
• School and college entry physicals;
• Child and adult flu and pneumonia immunizations;
• Wellness screenings for diabetes, high blood pressure, cholesterol, heart disease and body mass index;
• Screening, testing and education for STDs, HIV/AIDS and hepatitis;
• Referrals to follow-up care and targeted wellness programs such as smoking cessation.

In addition to providing primary care, chronic disease prevention is a main focus. The unit will seek to detect major diseases for residents who lack the income or resources to visit a clinic. Depending on their needs and resources, patients can be referred to other local healthcare facilities for further care. Bus vouchers are available for those who have no transportation.

Care is provided by an advanced registered nurse practitioner and a health support worker to anyone by appointment and to walk-up patients. The unit’s $300,000 annual operating budget is funded by Orlando Health, Healthy Start Coalition of Seminole County, True Health Family Health Centers, and the Women, Infants and Children (WIC) program.

Although county health departments operate mobile health units in Citrus, Sarasota and Dade Counties, the Seminole County unit is the only one serving Central Florida. While it only operates two days a week now, leaders hope to receive funding to expand to more days and hours.

The mobile health unit is in its initial few months of operation, so no statistics are available yet, but it is already being seen as a first step toward reaching more underserved residents.

Stories From the Saskatoon Health Bus

“The…client was a 94-year-old male, sharp as could be, curious about the bus. Stopped by to check us out. We engaged in conversation, took some vitals…[he had] an irregular heartbeat. We did a 12-lead ECG and found a-fib and a RBB. He did not take any meds and was asymptomatic. We were uncertain if this was a new onset. We made arrangements for a follow-up at the clinic. We gave him a copy of our 12-lead to present to [the doctor]. The bus is working!”

“[A] regular homeless fellow…came in for a dressing change on his leg for an injury he’d had for a month. It was getting worse, not better. He had been seen at the [named clinic] for a dressing change a week ago and was told he needed antibiotics. He told them no. Today I told him the same the same thing, and he said he would take them. So the NP wrote him a script [and provided education]…I think this proves that we are gaining trust in the community, even if it is just one person at a time.”

“The third was a lady who came by to have her BP taken. She said it is always high at the doctor’s office, as she gets anxious. It was high for us as well, and we prompted her to make sure she took it again at home to see if it came down. [The staff] also realized she had an irregular heartbeat and put her on the monitor. She was in a-fib but stated she felt fine. She had a regular doctor’s appointment soon, so she was happy to take the ECG strip and tell the doctor what we had found. She also called back twice during the evening to tell us her meds and reassure us she had taken her BP at home and it was fine then.”

“She arrived very pale and in distress. She was directed to the ER for labs and ultrasound. She returned wanting to personally thank those for the care she received. As it turned out they found two tumors, one on each kidney, less than a centimeter in diameter. She will be going for a CT and surgery to determine if there is any cancer. A young mother with children, employed in a low-paying occupation and stress leaking out. Thanks to…[the named nurse and paramedic] for your care.”

—Source: https://www.saskatchewan.ca/

Ed Mund began his fire and EMS career in 1989. He currently serves with Riverside Fire Authority, a fire-based ALS agency in Centralia, WA. His writing and photos have appeared in several industry publications. Contact him at mund.ed@comcast.net.