Bridging gaps in care: Evaluation of a mobile health model addressing social determinants and harm reduction in Eastern Puerto Rico

The harms associated with substance use continue to disproportionately affect marginalized populations. This study presents a retrospective program evaluation of a mobile health unit that delivers integrated clinical and harm reduction services to marginalized populations in Eastern Puerto Rico. 

METHODS: A secondary data analysis was conducted using administrative data from a mobile health unit, capturing client encounters, service utilization (e.g., mental health support, health screenings, safe injection counseling, and case management), visit frequency, and demographic characteristics. This study is framed as an implementation-focused program evaluation. Descriptive and exploratory analyses were conducted to assess service delivery, program reach, utilization patterns, and selected program outcomes over a 1.5-year period. 

RESULTS: Between January 2022 and October 2023, the mobile health unit served 279 participants across eight municipalities. Participants exhibited higher rates of intravenous drug use, mental health disorders, homelessness, and incarceration history compared with previously published estimates for the general Puerto Rican population, although these comparisons are indirect. The program delivered multidisciplinary services and facilitated referrals addressing key social determinants of health, including housing, nutritional assistance, identification services, in-patient treatment, and medication-assisted treatment. Model-based estimates using the Mobile Health Map Impact Tracker tool suggest that, in 2023, mobile health screenings may be associated with a return on investment of approximately 6:1, 259 avoided emergency department visits, 29 life-years saved, and approximately USD 2.4 million in healthcare cost savings. 

CONCLUSIONS: This evaluation demonstrates the feasibility of a mobile health model integrating harm reduction and clinical services to reach highly marginalized populations and facilitate connections to health and social services. Findings reflect program implementation, service reach, and engagement rather than causal effectiveness. Mobile health approaches may represent a feasible and potentially beneficial strategy for expanding access to care, although further research incorporating patient-level outcomes is needed to assess effectiveness.