A new 36-foot medically equipped Community Health Care Van will travel throughout New Haven neighborhoods to bring health care to hidden or medically underserved populations, including intravenous drug users. A number of these patients, many of whom have had no recent health care, will be treated for acute health care problems at the van and then referred to community-based health providers.
The mobile medical clinic is the centerpiece of an innovative research and evaluation project, considered to be one of the newest national models to provide health care to drug users and other medically underserved city residents, according to Dr. Frederick L. Altice, assistant professor of medicine at the School of Medicine and a member of the Yale AIDS Program.
The new van and related aspects of the research and evaluation project are supported by a four-year, $3 million grant made to the School of Medicine by the National Institute on Drug Abuse. Dr. Altice is this grant's principal investigator.
In bringing health care services to underserved populations, Dr. Altice and his colleagues hope to determine whether this care and other directed efforts will help decrease or alleviate emergency department visits for acute health care problems and increase utilization of primary care services.
The Community Health Care Van itself is a community project sponsored by the School of Medicine, the Hospital of St. Raphael, the City of New Haven and its Health Department, Yale-New Haven Hospital, the Hill Health Center, Fair Haven Community Health Clinic and the APT Foundation. The project seeks to provide a means for directing individuals into medical care and drug treatment programs, enhancing social services and improving access to health care.
The Community Health Care Van offers outreach, education, referrals to drug treatment and social service programs, and serves as an introduction to primary care medical services. "We aim to do preventive outreach as a model to reflect the needs of the community," Dr. Altice says. This new van will travel throughout New Haven in tandem with the city's Needle Exchange Program. The van also will be used by another Yale program, the Medical Residents Training Program, which will continue to provide medical services one day a week to individuals at city soup kitchens.
Since the mobile medical health clinic program's inception in 1993, more than 1,800 men and women between the ages of 20 and 45 have been served. "With the new van, we anticipate serving two and a half as many people in pockets of poverty," Dr. Altice notes.
The new van, which replaces a smaller one rented from the APT Foundation, includes two exam rooms, one counseling room, plus a waiting area.
The number of days that the van is in operation has been expanded from two days a week to five, and the staff has been increased, bringing its complement up to 10. These include physicians-in-training, physician associates, a nurse practitioner, drug treatment coordinator, case manager, clinical coordinator, a driver/outreach worker and members of the study staff. Some members are bilingual. "The new mobile health clinic will allow our staff to provide all of the existing services, plus expanded clinical, outreach/prevention and referral services," says Dr. Altice.
"We will look at the impact of expanding needle exchange-based medical services on a community health care van," Dr. Altice says. "As we introduce this expanded mobile medical service, we will evaluate whether it changes patterns and ways people use the health care system in a middle-sized city."
As part of this federally funded project, the Yale team will follow 500 drug users and look at how they utilize health care services. "We will see if people who have repeated interaction with the van change from episodic and fragmented care to primary care. We also will explore how different people perceive health care, and how and why drug users use certain kinds of care," adds Dr. Altice, who has extensive experience in treating medical problems of active drug users and HIV-infected patients.