Equitable availability of health care services in underserved communities remains a challenge in the United States. The centralized nature of the traditional medical testing laboratory contributes to these challenges, as well as socioeconomic and demographic reasons, especially in rural communities. Regular testing and routine substance abuse monitoring is key to the successful treatment of patients in the ongoing opioid crisis. Though research demonstrates the success of mobile testing models all over the world, in the US, mobile testing for drug monitoring remains an untapped resource.
The disruption of regular medical and laboratory services during the COVID19 pandemic has only made these issues more critical. According to a 2020 report by Czeisler and colleagues, Americans have reported increased substance use to cope with distress associated with the COVID-19 pandemic. And in May 2020, the Overdose Detection Mapping Application Program (ODMAP) reported a 20 percent increase in overdoses since the first reported cases of COVID-19 in the US. The lack of support toward mobile clinics has contributed to the lack of testing and treatment options during the COVID-19 pandemic.
The pandemic has highlighted the importance and effectiveness of nontraditional approaches in maintaining health care services. The flexibility and adaptability of mobile clinics make them ideal for national emergencies such as a pandemic. In this regard, mobile laboratory testing services can help address a number of issues that prevent effective public access to laboratory services in underserved communities.
COVID-19 and the opioid crisis in rural America
According to the American Health Association, an estimated 57 million Americans reside in rural areas. Residents in rural communities face greater challenges when accessing health care due to geographic location, lower availability of testing equipment/programs, staffing shortages in rural hospitals, and difficulties pertaining to insurance and reimbursement plans. These health care challenges put patients living in rural/remote areas at higher risk of health issues, such as mental health conditions and drug and substance use disorders (SUDs). In terms of opioid abuse, researchers have found that mortality rates due to opioid abuse have increased at a higher rate in rural areas than in urban ones.
These challenges became more evident, and to some extent dire, during the COVID-19 pandemic.
The pandemic has not only led to a rise in morbidity and mortality, but also a rise in mental health disorders. While there seemed to be an increase in demand for anti-depressants and antianxiety and substance use medication during the initial months of pandemic, the Centers for Disease Control and Prevention recommended that medical treatment and prevention services that couldn’t be performed virtually be postponed. This led to a large decline in routine compliance drug monitoring to assess patient adherence to prescribed drugs, as well as to monitor non-prescribed drug abuse/misuse.
The current state of mobile clinics in the US
According to the Mobile Health Map project, a collaborative research initiative tracking and evaluating the impact of mobile testing, there are 2,000 mobile medical clinics and testing facilities that serve low-income communities of approximately 7 million people within the US.
These mobile health clinics provide a wide variety of general and specialized services that help support the health care infrastructure and facilitate outreach, especially among the underserved and disadvantaged populations, making diagnostics, testing, and treatment options available in inaccessible areas.
Mobile clinics meant for drug testing provide routine drug testing, medication assisted treatments, and counselling sessions to substance abuse disorder and addiction patients, as well as health screening, preventative care, and chronic disease management—mainly hepatitis C and HIV—which are syndemic of SUDs.
Challenges of mobile testing
Mobile drug testing facilities face several challenges on a regular basis, including funding, the insurance status of patients, logistics and maintaining supply chains, and spatial constraints, among others.
Though the data collected from mobile testing sites have demonstrated an improvement in patient outcome, continuity of care, and lowered economic burden with respect to direct and indirect health care costs, there is a need for an integrated system to track patient care, treatment plan, and medical history. Reliable maintenance of patient records and data transfer is crucial to continuity of care. To be successful, all labs must be in sync with hospitals, pharmacies, and payors to provide quality patient care. These aspects are even more important for a mobile facility due to irregular community support and funding and the transitory nature of the testing service—especially for medication-assisted treatment programs and drug compliance monitoring for substance use disorders.
Proper working model
There are many diagnostics labs that perform routine drug testing in the US via mobile testing for the workplace. In this model, mobile clinics visit work sites, collect samples, and provide results. However, this model does not translate well to routine compliance drug monitoring for patients with history of substance abuse or mental health disorders.
Finding employees to reliably operate mobile clinics can be challenging. Not only must the staff members operating mobile testing clinics be trained to perform all the diagnostics tests offered, as well as in patient data management, they must also be empathic, nonjudgmental, and capable of fostering a trustworthy environment. In addition, staff must agree to flexible work hours due to the mobile nature of the clinic.
Mobile drug testing may offer a solution
Studies and clinical trials are underway in the US to assess the effectiveness of mobile clinics in mitigating SUDs, mental health, and prevention of infections caused by injection drug abuse.
In one study, a 3-week mobile unit pilot program was set up to help assist SUD patients with drug monitoring. Completed in 2020, the study demonstrated that mobile testing was not only cost-effective, but also effective in providing access to testing to a vulnerable population that otherwise wouldn’t have received any testing during the pandemic (9).
Currently, a study funded by the National Institutes of Health (NIH) is assessing the efficacy of mobile clinics for delivering integrated health services for HIV and substance use patients. Here, the idea is to provide accessibility to the affected vulnerable population.
Further studies are also needed to assess the logistical and overall health care costs rendered for mobile clinics as compared to community clinics and hospitals.
A plan for the future
Though the COVID-19 pandemic has exacerbated the opioid crisis in vulnerable communities, public health initiatives created to deal with the pandemic present unique opportunities to enhance mobile drug testing. Both public and private entities improvised to overcome logistical and infrastructure issues related to mobile sample collection, integrated patient data management, and remote consultations, including challenges related to telemedicine and virtual consultations and treatment services. And during the pandemic, insurers and insurance agencies have come to recognize the necessity of mobile testing for faster diagnosis and treatment turnaround times. A similar approach could be leveraged to cross-train mobile drug testing staff to provide services in underserved areas, especially during public health emergencies.