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Table 4 Included primary health care mobile clinic models for Indigenous populations

From: Mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States: a systematic scoping review

MOBILE PRIMARY HEALTH CARE MODEL
Mobile health clinic name Target population Services providedwd Indigenous community involvement Evaluation methods Participant sample Evaluation Outcomes Mobile clinic funding source
Health E Screen 4 Kids Aboriginal and Torres Strait Islander children (aged > 18 years) Screening, surveillance, primary care health checks and ENT surgery (e.g. taking out adenoids, putting in grommets) In partnership (1) Feasibility study [51]
(2) Cost-effectiveness analysis [52]
(3) Pre and post-intervention analysis of hospital ENT service utilization [53]
(4) Retrospective review of service activity from 2009 to 2011 [55]
(5) Retrospective review of service activity from 2009 to 2014 [54]
(1) Aboriginal and Torres Strait Islander children aged between 0 and 16 years receiving service between February and July 2009 (n = 743)
(2) Annual costs of mobile van including services delivered, staff costs, maintenance costs and fixed costs
(3) ENT outpatient appointments at Royal Children’s Hospital (2006–2008 n = 329) and (2009–2011 n = 105)
(4) Children registered with the service (n = 1053)
(5) Children registered with the service (n = 3105)
(1) 41% of children failed one or more components of ear-screening assessment, 12% had signs of hearing impairment and 15% failed vision-screening assessment with 157 referrals to ENT specialists for review
(2) Estimated cost for mobile van was higher than control (Deadly Ears Program), however generated high QALYs (15.94 v. 15.90) than control. Found to be a cost-effective strategy
(3) Increase in routine assessment of children, increase in ENT surgical procedures locally and reduced need for families to travel to tertiary centers
(4) High screening rates of children as a result of service with 2111 screening assessments undertaken and reduced wait times for ENT specialist review
(5) Since service commenced, the number of screening assessments completed per year has increased (2009 n = 752, compared to 2014 n = 1454), increase in patients and decrease in proportion of children failing screening assessments and being referred to ENT.
University of Queensland, Centre for Online Health and Royal Children’s Hospital Foundation
Bega Garnbirringu Health Service mobile clinic All Aboriginal and Torres Strait Islander people Primary care services delivered by GP, RN and AHWs such as wound care, health screenings (including sexual health), chronic disease management, pathology services (including Point of Care (PoC) testing), health education, annual Aboriginal and Torres Strait Islander health checks and visiting specialist services. Implemented and delivered by an Aboriginal Community-Controlled Health Organisation None to report None to report None to report Not reported
Maari Ma Health Aboriginal Corporation mobile clinic All Aboriginal and Torres Strait Islander people Opportunistic health service delivery at community and sports events including health promotion and influenza vaccination Implemented and delivered by an Aboriginal Community-Controlled Health Organisation None to report None to report None to report Australian Commonwealth Government
University of Queensland Indigenous Health Mobile Training Unit (MOB van) All Aboriginal and Torres Strait Islander people Primary health care including GP assessments, opportunistic health checks and school health checks Implemented and delivered in partnership with an Aboriginal Community-Controlled Health Organisation Descriptive statistics for 2014 annual report [62] Clients of service Multiple outcomes including 50% increase in the number of active clients, triple the number of GPs employed in 2014 compared to 2013, an increase in the number of completed health checks by 29% and funding secured for a new clinic in Warwick. Queensland Health, Health Workforce Australia
Moorditj Djena mobile podiatry clinic All Aboriginal and Torres Strait Islander people Diabetes self-management and education including podiatric assessment. Implemented and delivered by an Aboriginal Community -Controlled Health Organisation Mixed methods including focus groups, interviews, review of program documents and descriptive analysis of clinical and administrative data [63]. Clients of service (n = 702) Multiple outcomes including 3500 occasions of service in first 2.5 years and identified that outreach capacity is a strength.
Multiple challenges including planning and coordination of outreach clinics, recruitment of staff and staff turnover, van procurement, launch and ongoing promotion of clinical service, ordering of equipment and logistical organisation, development of a database for electronic record keeping and negotiating fees to minimize costs to clients.
National Partnership Agreement for ‘Closing the Gap’ in Indigenous Health Outcomes
Western Desert Kidney Health mobile bus All Aboriginal and Torres Strait Islander people Early detection of disease, chronic disease management and health promotion Implemented and delivered in partnership with Aboriginal organisations (1) Qualitative interviews [65]
(2) Community based participatory research project with annual cross sectional surveys over 3 years [66]
(1) Aboriginal people living in remote communities receiving service (n = 26)
(2) Aboriginal people from 10 locations
(1) Found to be highly acceptable and effective means of disseminating the importance of prevention, early detection and management of diabetes and kidney disease
(2) Multiple outcomes including high participation rate of Aboriginal people (79%), higher than predicated rates of diabetes, hypertension, hematuria and ACR and Aboriginal women found to be the highest risk group
BHP Billiton Nickel West, University Western Australia, University of Notre Dame, Bega Garnbirringu Health Services, Goldfields Esperance GP Network and Wongutha Bimi Aboriginal Corporation
Budja Budja Aboriginal Cooperative All Aboriginal and Torres Strait Islander people Primary health care services including audiology, optometry, general health checks and health promotion and education Implemented and delivered None to report None to report None to report Deakin University School of Medicine, Department of Prime Minister and Cabinet (Indigenous Affairs) and Budja Budja Aboriginal Coopertaive
Queensland Aboriginal and Islander Health Council (QAIHC) mobile health clinic Aboriginal and Torres Strait Islander people Primary health care services Not reported None to report None to report None to report Queensland Gas Company (QGC)
Goondir Health Services Mobile Medical Clinic Aboriginal and Torres Strait Islander people, including school-aged children Primary health care including disease prevention and chronic disease management, men’s and women’s health and health checks in schools Delivered by an Aboriginal Community Controlled Health Organisation Descriptive statistics of services delivered [69] Clinic data Multiple outcomes including 187% increase in number of patients over 4 years. Queensland Health, Broncos and Goondir Health Service
Earbus mobile health clinics Aboriginal and Torres Strait Islander children and young people Primary and secondary services including ear screening, surveillance and treatment by GPs, audiologist and ENTs Partners with Aboriginal Community-Controlled Health Service to deliver health services. Regional descriptive statistics of services delivered [71] Patient records Multiple outcomes reporting on disease prevalence and screening rates in patient cohort stratified by geographical region Earbus foundation of WA (charity) receiving multiple sources of funding (e.g. Neilson Foundation, ALCOA, MZI Resources and Ian Potter Foundation)
Chevron-Pilbara Ear Health Program Aboriginal and Torres Strait Islander school-aged children Primary and secondary services including: ear health checks, hearing screening, Nurse Practitioner consultations and appointments with Ear Nose and Throat Specialists. Partner with Aboriginal communities, Elders, schools and other health services to deliver health services. (1) Descriptive statistics of services delivered [73]
(2) Descriptive statistics of attendance rates [74]
(3) Descriptive statistics in annual report [75]
(1) Patient and clinical data
(2) Clinical data 2014–2015
(3) Clinical data 2011–2019
(1) Multiple outcomes including number of schools accessed and outcomes of hearing tests (pass, review, refer)
(2) Increased attendance rates (40% pre July 2014 to 85.1% Jan-June 2015)
(3) Multiple outcomes including 10,137 ear health screenings for 4881 people.
Partners, Benefactors & Supporters;
Channel 7 Telethon Trust, Chevron, Western Australian Government, Lottery West, The Hearing Research & Support Foundation, The Crommelin Family, Bill 7 Rhonda Wyllie Foundation, Jack Bendat, Tony Fini Foundation, Stan Perron Charitable Trust, Frank Tomasi Family Trust, Toybox International, LD Total
Pi:Lu Bus All Aboriginal and Torres Strait Islander people Primary health services including education Aboriginal health service delivered None to report None to report None to report Bus provided by Transport South Australia
Murchison Outreach Services All Aboriginal and Torres Strait Islander people Primary care services including: general medical care, chronic disease and health promotion Operated and delivered by an Aboriginal Community Controlled Health Organisation None to report None to report None to report Not reported
Nhulundu Health Service Mobile Clinic All Aboriginal and Torres Strait Islander people Outreach medical services delivered by a GP, nurse and health worker Operated and delivered by an Aboriginal medical service None to report None to report None to report Not reported
Screening for Limb, I-eye, Cardiovascular, and Kidney complications of diabetes (SLICK vans) Alberta First Nations with diabetes Diabetes screening, education and counselling service with point-of-care laboratory equipment and a retinal camera Delivered in partnership with First Nations people (1) Descriptive analysis of patient cohort [80]
(2) Descriptive longitudinal analysis of clinical indicators [41]
(3) Descriptive quantitative analysis of key evaluation indicators [79]
(4) Preliminary evaluation [81]
(1) Participants who completed screening and survey (n = 743)
(2) Patients screened with diabetes 2001–2007 (n = 2102)
(3) Patient and clinic data between 2001 and 2007
(4) First Nations people with known diabetes 2001 to 2003
(1) Various clinical indicators, service utilization and health literacy.
(2) Significant improvements in BMI, blood pressure, total cholesterol and HbA1c were identified (p < 0.01) in returning patients
(3) Multiple outcomes including clinic visits (n = 830), annual costs avoided by patients and changes in clinical indicators (e.g. mass (kg), BMI, HbA1c, BP, MAP, LDL and total cholesterol)
(4) Screened n = 1151 clients, modest improvements in program outcomes at 6 to 12 months
Canadian Health Infostructure Partnership Program (CHIPP), Health Canada and Aboriginal Diabetes Initiative
Mobile Diabetes Screening Initiative (MDSi) Metis adults (aged 18 years and over) and other remote Indigenous communities Diabetes screening service Implemented in partnership with Metis communities (1) Descriptive cross-sectional quantitative study with multiple measures (e.g. body mass index (BMI), waist circumference, blood pressure, blood glucose, blood lipids and HbA1c) [82]
(2) Telephone survey [83]
(3) Longitudinal analysis [84]
(1) Patients screened with fasting glucose without a known history of diabetes (n = 266) between 2003 and 2007
(2) Adult patients (n = 175) between 2003 and 2008
(3) Clinical data from 2003 to 2009
(1) Prevalence of undiagnosed diabetes was 5.3% and pre-diabetes was 20.3% (CDA criteria) and 51.9% (ADA criteria)
(2) 51% of participants indicated GP follow up after screening, with 66% of those who had been told they had probable diabetes, visiting a physician.
(3) For returning adults with diabetes, significant improvements (p < 0.05) were observed in BMI, blood pressure, total cholesterol and HbA1c.
Alberta Health and Wellness Program
Seabird Island Mobile Diabetes Telemedicine People with diabetes residing in 70 First Nation reserve communities in southern mainland BC Eye exam, PoC laboratory tests, nurse assessment, diabetes management and education Directed by members from tribal councils Descriptive quantitative analysis of key evaluation indicators [79] Patient records with diabetes (n = 1160) 2010–2013 Multiple outcomes including patient mean avoided cost ($260,027 per year) and mean difference in clinical indicators of diabetes (although not statistically significant): body mass − 0.5 kg, HbA1c −0.08%, systolic blood pressure 1.1 mmHg, diastolic blood pressure − 0.5 mmHg, Mean Arterial Pressure (MAP) 0.1 mmHg, Low Density Lipids (LDL) -0.13 mmol/L Health Canada, Aboriginal Diabetes Initiative and British Columbia agencies including Fraser Health Authority and First Nations Health Authority.
Manitoba Diabetes Integration Project (DIP) People with diabetes residing in 19 First Nation reserves in Manitoba PoC laboratory tests, nurse assessment and diabetes management and education advice Directed by members from tribal councils Descriptive quantitative analysis of key evaluation indicators [79] Patient records with diabetes (n = 2790) between 2008 and 2013 Multiple outcomes including patient mean avoided cost ($272,289 per year) and change in mean difference of clinical indicators of diabetes: mass − 0.4 kg, HbA1c − 0.09%, systolic blood pressure − 1.6 mmHg, diastolic blood pressure − 1.0 mmHg, MAP −1.1 mmHg, LDL 0.09 mmol/L Health Canada and Aboriginal Diabetes Initiative
Mobile Diabetes Telemedicine Clinic (MDTC) People with diabetes residing in 59 First Nations communities in Northern British Columbia Diabetes screening and management including eye exam, point of care (PoC) testing, nursing and dietitian assessments and education Delivered by First Nations health service Longitudinal cohort data analysis [79, 87] Patient records from 2003 to 2009 Modest improvements in some clinical outcomes (e.g. mean decline in body mass of 1.6 kg, mean decline in LDL was 0.3 mmol/L, mean absolute decline in A1c was 0.4%) Health Canada and Aboriginal Diabetes Initiative
Great Plains Mobile Mammography Screening Native American and Alaskan women Mammography screening and referrals to tertiary centers Delivered by Indian health services (1) Retrospective analysis of clinic records [89]
(2) Retrospective analysis of clinical records [90]
(1) Native Indian and Alaskan Native patient records 2007–2009 (n = 2640)
(2) Complete patient records from 2007 to 2009 (n = 1771)
(1) Incomplete patient reports were more frequent in mobile mammography than the fixed site (21.9% v. 15.2%)
(2) Adherence to screening guidelines found in 39.86% of patients
Not reported
Tuba City Regional Health Care Corporation Mobile Health Program Native Indian people from Navajo, Hopi and San Juan Southern Paiute tribes Primary Healthcare including immunizations and dental exams Delivered by an Indian Tribal Organisation None to report None to report None to report Health Resources and Services Administration (Grant)
Winslow Indian Health Care Centre Medical Mobile Vehicle Native Indian people Primary care, dental, pharmacy, public health nursing, physical therapy, and some specialty services. Delivered by Indian health service None to report None to report None to report Not reported
Bay Clinic Mobile Health Unit East Hawai’i residents Primary health care including preventative care, treatment, urgent care, immunization and vaccines, chronic disease management and dental services Delivered by an East Hawai’I community health service None to report None to report None to report The Harry & Jeanette Weinberg Foundation, Inc., Hearst Foundations, Atherton Family Foundation, HDS Foundation, USDA/Rural Development, County of Hawai’i, McInerny Foundation, Ouida & Doc Hill Foundation, The Shippers Wharf Committee Trust
Mniwiconi clinic and farm Mobile Clinic Indian tribal members Health care Indian delivered None to report None to report None to report Not reported
Wisconsin Ho-Chunk Nation mobile clinic Indian babies, children and young people Primary healthcare including acute care, laboratory services, vision and hearing screening, immunisations and other preventative care, education (e.g. asthma management, obesity prevention) Delivered in partnership with an Indian Department of Health None to report None to report None to report Idol Gives Back Foundation (philanthropic)