What is the aim of this review?
The aim of this Cochrane Review was to assess the effects of mobile clinics on women’s and children’s health. Cochrane researchers searched for and analysed all relevant studies to answer this question.
The review only included two studies. One included study showed that mobile clinics may increase the number of women who use mammography services, although the cost of mammography screening may be higher. The other study showed that mobile clinics may make little or no difference to children’s asthma symptoms, their use of medication and urgent care, or their caregivers’ quality of life. More studies are needed, including studies that measure the effect of mobile clinics on cost and on people’s access to healthcare, their satisfaction, health, and well-being.
What was studied in the review?
In many settings, people have poor access to healthcare services because they live in remote or hard-to-reach areas. Women and children may find it very difficult to access health services because of financial or social circumstances.
One way to increase people’s access to healthcare services is by providing mobile clinics. A mobile clinic is a vehicle with a driver and clinical equipment, and is staffed by a healthcare provider, such as a doctor or nurse, that visits areas regularly to provide health services.
Mobile clinics are used in many countries and are often used to offer health services to women and children, such as antenatal care, childhood immunisation, family planning services, and breast cancer screening.
By taking health services to the community through mobile clinics, governments hope to increase the use of these services and improve people’s health. This Cochrane review aimed to explore the effect of mobile clinics on people’s access to and use of health care and on their satisfaction, health, and well-being; as well as their cost and cost effectiveness, compared to permanent clinics.
What are the main results of the review?
The review authors included two studies, which were from the USA.
In the first study, women were either offered health education and mammography screening in mobile clinics or health education only including reminders to attend a permanent clinic that offered mammography screening. The study showed that:
· women offered mammography in mobile clinics may be more likely to undergo mammography (low certainty evidence);
· the cost of screening per woman may be higher for mobile clinics than for permanent clinics (low certainty evidence).
This study did not assess the effect of the mobile clinics on women’s health and well-being, their access to services or their satisfaction with these services.
In the second study, children were offered asthma care either at mobile clinics or at their usual primary care provider. This study showed that mobile clinics:
· may make little or no difference to the children’s asthma symptom-free days or their use of urgent care and medication (low certainty evidence);
· may make little or no difference to the quality of life of the children’s caregivers (low certainty evidence).
The study did not assess the effect of the mobile clinics on children’s access to services or their satisfaction with these services, or on the cost and cost-effectiveness of using the mobile clinics.
How up-to-date is this review?
The review authors searched for studies that had been published up to April 2015.
The paucity of evidence and the restricted range of contexts from which evidence is available make it difficult to draw conclusions on the impacts of mobile clinics on women's and children's health compared to static clinics. Further rigorous studies are needed in low-, middle-, and high-income countries to evaluate the impacts of mobile clinics on women's and children's health.
The accessibility of health services is an important factor that affects the health outcomes of populations. A mobile clinic provides a wide range of services but in most countries the main focus is on health services for women and children. It is anticipated that improvement of the accessibility of health services via mobile clinics will improve women's and children's health.
To evaluate the impact of mobile clinic services on women's and children's health.
For related systematic reviews, we searched the Database of Abstracts of Reviews of Effectiveness (DARE), CRD; Health Technology Assessment Database (HTA), CRD; NHS Economic Evaluation Database (NHS EED), CRD (searched 20 February 2014).
For primary studies, we searched ISI Web of Science, for studies that have cited the included studies in this review (searched 18 January 2016); WHO ICTRP, and ClinicalTrials.gov (searched 23 May 2016); Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.cochranelibrary.com (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 7 April 2015); MEDLINE, OvidSP (searched 7 April 2015); Embase, OvidSP (searched 7 April 2015); CINAHL, EbscoHost (searched 7 April 2015); Global Health, OvidSP (searched 8 April 2015); POPLINE, K4Health (searched 8 April 2015); Science Citation Index and Social Sciences Citation Index, ISI Web of Science (searched 8 April 2015); Global Health Library, WHO (searched 8 April 2015); PAHO, VHL (searched 8 April 2015); WHOLIS, WHO (searched 8 April 2015); LILACS, VHL (searched 9 April 2015).
We included individual- and cluster-randomised controlled trials (RCTs) and non-RCTs. We included controlled before-and-after (CBA) studies provided they had at least two intervention sites and two control sites. Also, we included interrupted time series (ITS) studies if there was a clearly defined point in time when the intervention occurred and at least three data points before and three after the intervention. We defined the intervention of a mobile clinic as a clinic vehicle with a healthcare provider (with or without a nurse) and a driver that visited areas on a regular basis. The participants were women (18 years or older) and children (under the age of 18 years) in low-, middle-, and high-income countries.
Two review authors independently screened the titles and abstracts of studies identified by the search strategy, extracted data from the included studies using a specially-designed data extraction form based on the Cochrane EPOC Group data collection checklist, and assessed full-text articles for eligibility. All authors performed analyses, 'Risk of bias' assessments, and assessed the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Two cluster-RCTs met the inclusion criteria of this review. Both studies were conducted in the USA.
One study tested whether offering onsite mobile mammography combined with health education was more effective at increasing breast cancer screening rates than offering health education only, including reminders to attend a static clinic for mammography. Women in the group offered mobile mammography and health education may be more likely to undergo mammography within three months of the intervention than those in the comparison group (55% versus 40%; odds ratio (OR) 1.83, 95% CI 1.22 to 2.74; low certainty evidence).
A cost-effectiveness analysis of mammography at mobile versus static units found that the total cost per patient screened may be higher for mobile units than for static units. The incremental costs per patient screened for a mobile over a stationary unit were USD 61 and USD 45 for a mobile full digital unit and a mobile film unit respectively.
The second study compared asthma outcomes for children aged two to six years who received asthma care from a mobile asthma clinic and children who received standard asthma care from the usual (static) primary provider. Children who receive asthma care from a mobile asthma clinic may experience little or no difference in symptom-free days, urgent care use and caregiver-reported medication use compared to children who receive care from their usual primary care provider. All of the evidence was of low certainty.