Mobile –Portable System Case Study on Decision Making

The Problem

A recent oral health needs assessment in your community revealed a high level of untreated dental decay among school children from low-income families. A local health advisory group decides to make addressing this health problem a high priority. There are few sources of dental care available and/or affordable to low-income families and the demand for dental care at the community health clinic already surpasses clinic capacity. For a variety of reasons, most of the children do not have a "dental home."

Potential Solutions

Reasonable choices are 1) to carve out time in the schedule of the already busy clinic and arrange for some type of referral, case management and transportation program that brings the children from their schools to the clinic (school-linked) or 2) to develop a program that provides treatment at the schools (school-based), either by a) building a fixed-site dental clinic at one or more of the schools and transporting children to the site, b) utilizing portable dental equipment on school grounds, or c) using a self-propelled mobile clinic that travels from school to school.

Pros and Cons

          School-Linked Program

While the school-linked program might be the least costly, it doesn't add any capacity to the system. It merely displaces some of the people who have been using the clinic site for their care with children who haven't, thus merely shifting the access problem from one group to another. Referral programs are not quite as simple as they would seem. They require intensive coordination by an individual skilled in working with school administrators and school nurses around school schedules, and with transportation companies that are not always reliable, and with dental staff at one or multiple dental treatment sites. 

          School-Based Dental Clinic

A fixed site clinic may appear to be the ideal answer because the care is available on site, the problem of missed appointments is eliminated, and time away from the classroom is minimized. Unless clinics are built in multiple schools, however, a fixed site school-based dental clinic is only school-based for the school where it exists. The other "feeder" schools, which planners usually assume will send most of their children to the school-based clinic, will experience the same barriers as the school-linked referral challenges noted above. Therefore, the fixed site is school-based for only one school and school-linked for the rest. This model also requires hiring a clinic coordinator.

          Use of Portable Dental Equipment

Setting up portable equipment that can be moved from site to site addresses the school-based vs school-linked issues. It also is the least costly for purchasing equipment. However, it is the least ergonomically satisfactory for dental team members. Chairs may not be as adjustable, practitioner stools not as sturdy, and lights not as bright, all of which can result in less comfort and more physical and mental stress for the dental provider, especially is used many hours per week. Portable equipment must be built to be light enough to carry, which sometimes compromises design. Although use of portable equipment is often the best option for providing preventive services in schools, it may not be the best solution for providing restorative or surgical care on a regular basis.

          Mobile Dental Van

A single mobile 2-3 chair dental office built on a commercial vehicle chassis can capture many of the benefits of a fixed dental clinic, while eliminating some of the problems associated with the other programs just described. It solves the ergonomics concerns of portable equipment, although at significant expense, and eliminates the need for a school to dedicate space for an onsite clinic or to set up the portable equipment. It negates the problem of transporting children and lower participation rates from feeder schools, as well as the cost of a coordinator in a school-based model. Mobile vans can be equipped with the same dental chairs, units, lights, etc found in fixed-site dental clinics, and, through creative scheduling, could be used at other sites when schools are on vacation or closed for other reasons. The cost of one well-built, well-equipped dental van, which might go to 3-6 schools in a year, is less than the cost of building 3 small fixed clinics.