(105) The Impact of Street Medicine and Mobile Clinics for Persons Experiencing Homelessness

Background & Introduction: An estimated 5,800-46,500 lives are lost due to the condition of homelessness each year. Experiencing homelessness and poor health are cyclically related, with one reinforcing the other. Healthcare costs in the United States account for half of personal bankruptcies and put an individual at risk for eviction and homelessness. Alternatively, experiencing homelessness increases an individual’s risk of poor health psychologically and physically. Data in the United States suggests that the number of persons experiencing homelessness (PEH) is rising as the cost of living grows. The current healthcare delivery system is not capable of addressing structural barriers that prevent PEH from receiving healthcare. Mobile programs, which include mobile clinics, vehicles that travel to deliver care, and street medicine, the act of bringing care to spaces where PEH live, may play a role in alleviating this burden by providing free and accessible care to this community. We aim to review current literature on the role and impact of mobile programs for PEH. Limited research exists on street medicine, mobile clinics, and PEH. We hope to close this knowledge gap by summarizing current literature. No other formalized review we are aware of exists on this topic.

Methods: We conducted a literature review of peer-reviewed literature focused on the role of street medicine and mobile clinics in providing care for PEH by searching PubMed, Embase, and Web of Science on August 10, 2023. Only articles from 2013-2023 focused on the United States were included. The primary outcome was the role and impact of these programs in the provision of care for persons experiencing homelessness. The screening was done in a stepwise process using Covidence. First, articles were imported into Covidence (August 10th, 2023), then titles and abstracts were screened, and lastly, full texts were reviewed. Data was extracted to Excel and Endnote was used for citation management.

Results: 12 articles were included in this review. The included studies were predominately descriptive, summarizing services offered by current programs. (A) Descriptive findings emphasized that street medicine and mobile clinics provide behavioral health services. Mainly providing services for substance use disorders. Medication Assisted Therapy, including the prescription and follow-up care of buprenorphine was reported. Naloxone was also commonly distributed. Primary care services were also a significant component of the care provided. This encompassed vaccination delivery, medical consultations, medication dispensation, wound care, and point-of-care testing. Delivery of social services represented the multidisciplinary nature of these programs by providing help with insurance enrollment and housing placement. (B) Studies that qualitatively interviewed individuals receiving care from a street medicine team reported feeling less stigma from street medicine providers and that care was more accessible. (C) Lastly, findings indicate street medicine programs positively impact the health system through their ability to defer emergency department and hospital visits, making them financially beneficial.

Conclusion & Discussion: Mobile clinics and street medicine programs that serve PEH provide a wide range of services and have a positive impact. These findings implicate the importance of mobile programs that prioritize persons experiencing homelessness. One limitation was the lack of quantitative data comparing mobile programs with traditional clinical settings. Additionally, the exclusion of gray literature is a limitation as more information may be found in these sources. While more significant structural change is needed to address healthcare costs and housing policies in the United States, mobile clinics and street medicine teams' harm reduction services improve healthcare access and the healthcare system.

References: Hochman, M., & Robinson, J. (2021). From the hospital to the streets: Bringing care to the unsheltered homeless in Los Angeles. Healthc (Amst), 9(3), 100557. https://doi.org/10.1016/j.hjdsi.2021.100557

Lynch, K. A., Harris, T., Jain, S. H., & Hochman, M. (2022). The Case for Mobile "Street Medicine" for Patients Experiencing Homelessness. J Gen Intern Med, 37(15), 3999-4001. https://doi.org/10.1007/s11606-022-07689-w

Paradis-Gagné, E., Kaszap, M., Ben Ahmed, H. E., Pariseau-Legault, P., Jacques, M. C., & Potcoava, S. (2023). Perceptions of mobile and acute healthcare services among people experiencing homelessness. Public Health Nurs, 40(1), 36-43. https://doi.org/10.1111/phn.13150

Pepin, M. D., Joseph, J. K., Chapman, B. P., McAuliffe, C., O'Donnell, L. K., Marano, R. L., Carreiro, S. P., Garcia, E. J., Silk, H., & Babu, K. M. (2023). A mobile addiction service for community-based overdose prevention. Front Public Health, 11, 1154813. https://doi.org/10.3389/fpubh.2023.1154813

Rasul, T. F., Morgan, O., Elkhadem, A., & Henderson, A. (2023). Soft tissue infection and follow-up for an unsheltered patient: the role of Street Medicine providers in bridging gaps in care. BMJ Case Rep, 16(2). https://doi.org/10.1136/bcr-2022-251082