post by Bill Gardner
Don Taylor has a thought-provoking post on the possibility of delivering health care to people who have trouble accessing care through a 'medical food truck':
The best food trucks I have visited provide good quality food at a relatively low cost, typically by consistently providing a narrow range of fare, and showing up where the customers are when they want to eat. In the same way, if Duke University Health System had an “ER on wheels” (or several) they could provide basic care at a lower cost than they do at the Duke ER, and could go to where the patients were.
This is great in so many ways: it recognizes that health care is as much a matter of logistics as human biology or, for that matter, finance. Health care fails at the level of delivery as often as it does at the level of biochemistry. So it's wonderful when someone thinks about a new way to do this.
That said, I will bet money that Duke already has an ER on wheels, in fact I am sure they have many. They are called ambulances, the original health trucks. Ambulances come in various kinds from basic transport services to mobile ICUs. In Nova Scotia, 'emergency' calls to ERs for paramedic service have been growing rapidly. Much of it is for non-emergent but necessary services for people who have trouble accessing care through other means: stereotypically, a single elderly person who has fallen. Emergency departments are researching efficient algorithms to triage emergency situations (which may require advanced paramedics, hyper-quick response, and an exotic truck) from non-emergent situations that can be addressed through less expensive mobile care. The problem of putting an ER on wheels isn't solved, but many parties are already working on it.
For me, the innovation in Don's idea is thinking about a food truck for primary rather than emergency care. After all, food trucks don't make emergency visits to individual houses. They provide ways for people to meet non-emergent food needs.
Primary care requires a setting where people can have an in-person meeting with health care professionals for assessments and prescriptions, and channels for on-going follow-up interactions that can often be carried out electronically. So the medical food truck would overcome the access barrier by bringing the medical office to the people. And a key part of the system would be the wireless link to a patient record system that could maintain contact with the patients after the contact, above all alerting them to where the truck is now and when it will next be in your neighborhood.
In my parents' day, primary care was delivered through the house call. Unless you are really house-bound (or very wealthy), that doesn't make much sense today. Among other things, primary care now involves a team of health professionals, and their tools do not fit into a small black bag. But they likely would fit into a big panel van.