O'Neill Meghan, Redelmeier Robert J, Michalski Camilla, Macaraeg Raymond, Gans Maureen, Schoffel Alice, Diemert Lori M, Ogbaselassie Luwam, Rosella Laura C, Boozary Andrew
Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
University Health Network, Toronto, ON, Canada.
Can J Public Health. 2025 Jan 13. doi: 10.17269/s41997-024-00962-x.
Despite Canada's single-payer health system, marginalized populations often experience poor health outcomes and barriers to healthcare access. In response, mobile health clinics (MHCs) have been deployed in several cities across Canada. MHCs are well established in the United States; however, little is known about their role and impact in a country with universal healthcare. We describe the implementation of an urban MHC and early learnings from a mixed methods process and outcome-oriented evaluation.
In February 2021, Parkdale Queen West Community Health Centre, TELUS Health for Good, and University Health Network's Gattuso Centre for Social Medicine partnered to launch a nurse practitioner‒led, community-based MHC in Toronto, Ontario. The MHC provides low-barrier primary healthcare, harm reduction, and mental health services at five convenient locations.
Through an intercept survey (n = 49) and semi-structured interviews (n = 10), we sought to understand the sociodemographic characteristics of clients, their experiences at the MHC, and barriers and facilitators to the MHC in comparison to traditional healthcare settings. Most clients surveyed reported being homeless (61%). Without the MHC, 37% of clients would have accessed care at an emergency department and 18% would not have sought care. Thematic analysis revealed two structural and two relational factors that improved care experiences and care access.
We demonstrate that in a single-payer health system, MHCs alleviate major barriers to care access for marginalized populations. Learnings provide context to the most salient factors influencing clients' decisions to seek care at MHCs and can inform how these outreach models are designed.
尽管加拿大实行单一支付者医疗体系，但边缘化人群的健康状况往往较差，且在获得医疗服务方面存在障碍。作为回应，加拿大多个城市已部署了移动健康诊所（MHC）。MHC在美国已广泛建立；然而，对于其在全民医疗保健国家中的作用和影响却知之甚少。我们描述了一个城市MHC的实施情况，以及从一个混合方法、以过程和结果为导向的评估中获得的早期经验教训。
2021年2月，帕克代尔皇后西街社区健康中心、TELUS健康公益组织和大学健康网络的加图索社会医学中心合作，在安大略省多伦多市推出了一个由执业护士主导的、基于社区的MHC。该MHC在五个便利地点提供低门槛的初级医疗保健、减少伤害和心理健康服务。
通过拦截式调查（n = 49）和半结构化访谈（n = 10），我们试图了解客户的社会人口特征、他们在MHC的经历，以及与传统医疗环境相比，MHC存在的障碍和促进因素。大多数接受调查的客户报告称无家可归（61%）。如果没有MHC，37%的客户会在急诊科接受治疗，18%的客户不会寻求治疗。主题分析揭示了两个结构因素和两个关系因素，这些因素改善了护理体验和护理可及性。
我们证明，在单一支付者医疗体系中，MHC减轻了边缘化人群获得医疗服务的主要障碍。研究结果为影响客户在MHC寻求治疗决策的最显著因素提供了背景信息，并可为这些外展模式的设计提供参考。
