Heller School for Social Policy and Management, Brandeis University, United States of America.
Heller School for Social Policy and Management, Brandeis University, United States of America.
J Subst Use Addict Treat. 2024 Sep;164:209428. doi: 10.1016/j.josat.2024.209428. Epub 2024 Jun 13.
People with substance use disorders (SUD) face many barriers to receiving evidence-based treatments including access to and cost of treatment. People who use drugs face stigma that limits access to traditional office-based clinics. With the goal of reducing morbidity and mortality, mobile clinics reduce many of these barriers by providing harm reduction and on-demand low-threshold medical care.
In 2020 Massachusetts Department of Public Health (DPH) Mobile Addiction Services Program expanded a program called Community Care in Reach building on its success in reducing barriers to care and increasing patient encounters. In the current evaluation we conducted site visits to the four new mobile clinics and conducted one individual semi-structured provider interview at each of the four clinics. In addition, we supported a monthly learning collaborative of staff in four agencies involved with this initiative. The current evaluation used the RE-AIM framework to analyze the implementation of the mobile clinics.
Clinicians described many challenges and opportunities. The typical patient is unhoused, having a substance use disorder, and disconnected from traditional pathways to care. Clinicians are able to initiate people on buprenorphine largely due to the trust they establish with patients. Referral networks are facilitated by established community linkages. The philosophy of care is patient-centered. Mobile clinics provide a wide range of healthcare services including harm reduction, although finding a location to park and relations with police can be challenging. The workflow is uneven due to the model that is built on unscheduled visits.
This study provides insight into how mobile clinics address the gaps in care for persons with OUD and fatal opioid overdoses. Harm reduction services are a critical intervention and financial sustainability of mobile clinics has to be tested.
患有物质使用障碍（SUD）的人在接受循证治疗方面面临许多障碍，包括治疗的可及性和成本。吸毒者面临的污名将限制他们进入传统的门诊诊所。为了降低发病率和死亡率，流动诊所通过提供减少伤害和按需低门槛医疗服务，减少了许多这些障碍。
2020 年，马萨诸塞州公共卫生部（DPH）流动成瘾服务计划扩大了一个名为社区关怀延伸的项目，该项目建立在减少护理障碍和增加患者就诊的成功基础上。在当前的评估中，我们对四个新的流动诊所进行了现场访问，并在每个诊所对四个诊所的四名提供者进行了一次单独的半结构化访谈。此外，我们支持参与该计划的四个机构的工作人员每月进行一次学习合作。当前的评估使用 RE-AIM 框架分析流动诊所的实施情况。
临床医生描述了许多挑战和机遇。典型的患者是无家可归者，患有物质使用障碍，与传统的护理途径脱节。临床医生能够通过与患者建立信任，使大多数人开始使用丁丙诺啡。通过建立的社区联系，方便了转诊网络。关怀理念以患者为中心。流动诊所提供广泛的医疗服务，包括减少伤害，但寻找停车地点和与警察的关系可能具有挑战性。由于非计划性就诊的模式，工作流程不均衡。
这项研究提供了关于流动诊所如何解决患有 OUD 和致命阿片类药物过量者护理差距的见解。减少伤害服务是一项关键干预措施，必须测试流动诊所的财务可持续性。
