Online Program

Mapping healthcare access for vulnerable populations: An analysis of utilization at a mobile medical clinic using geographic information systems

Tuesday, November 5, 2013

Britton Gibson, M.P.H., Yale School of Medicine, Department of Infectious Diseases, AIDS Program, Yale University, New Haven, CT
Debarchana Ghosh, PhD, Assistant Professor, Geography, University of Connecticut, Storrs, CT
Jamie Morano, M.D., M.P.H., Yale School of Medicine, Department of Infectious Diseases, AIDS Program, Yale University
Frederick Altice, MA, MD, Yale School of Medicine, Yale University, New Haven, CT
Background: Medical mobile clinics (MMCs) are innovative public health strategies that are documented as effective forms of healthcare delivery to reduce geographic, structural, and social barriers to care, particularly in vulnerable populations. However, information on distribution of MMC client origin and travel behaviors is limited. This study uses Geographic Information System (GIS) to map origins of clients utilizing MMC services in New Haven, CT, and to examine the importance of GIS in developing a spatial understanding of health-seeking and health-utilization behaviors. Methods: Client addresses from 2004 through 2011 were geocoded and aggregated to the census block group. MMC sites were then mapped and buffered to create a 5-mile catchment areas. Client demographics and services utilization within and without this radius were compared using Wilcoxon rank sum tests. Results: Of 7,700 total clients, 7056 (91.6%) lived within 5-miles of a MMC site (proximate), and 644 (8.4%) were outside (remote). Remote clients were significantly more likely to be White (53.3% vs. 22.5%, p<0.001), inject drugs (27.5% vs. 15.7%, p<0.001), receive opioid substitution therapy (18.9% vs. 7.7%, p<0.001), be HIV-infected (11.8% vs. 8.6%, p=0.006), and report mental illness (32.2% vs. 22.9%, p<0.001). Conclusions: Our analysis has found that CHCV's unique provision of targeted services draws clients far beyond local communities. Thus, GIS can provide important insight into the provision and utilization of unique services delivered in urban healthcare settings to marginalized populations with specific needs.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public

Learning Objectives:
Assess the spatial distribution of clients at a mobile medical clinic; Analyze sociodemographic and medical correlates of clients traveling significant distances to utilize care at this non-traditional venue.

Keyword(s): Access and Services, Geographic Information Systems

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I currently hold a postgraduate position at the Yale AIDS Program where my research focuses on HIV and substance abuse, particularly in regards to barriers to care and healthcare access. During my public health education, I was able to gain skills in quantitative, qualitative, and spatial analysis that have helped to inform the progression of my work with the clinical database from the Yale Community Health Care Van, a mobile medical clinic.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.