{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T04:43:32Z","timestamp":1776746612918,"version":"3.51.2"},"reference-count":34,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T00:00:00Z","timestamp":1776470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Mobile Healthcare Association"},{"DOI":"10.13039\/100006691","name":"Harvard Medical School","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006691","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/ijerph23040529","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T09:37:42Z","timestamp":1776677862000},"page":"529","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bridging Gaps in Care: Evaluation of a Mobile Health Model Addressing Social Determinants and Harm Reduction in Eastern Puerto Rico"],"prefix":"10.3390","volume":"23","author":[{"given":"Elisa","family":"Pujals","sequence":"first","affiliation":[{"name":"Intercambios Puerto Rico, #14 Antonio R. Barcel\u00f3, Esq. Calle Diego Zalduondo, Fajardo 00738, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glorimar","family":"Caraballo-Correa","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Internal Medicine, School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan 00977, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathia","family":"Ocasio Maldonado","sequence":"additional","affiliation":[{"name":"School of Behavioral & Brain Sciences, Ponce Health Science University, Sala Ponce, 388 Calle Luis F, Ponce 00716, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yelanesse","family":"Pastrana Gonzalez","sequence":"additional","affiliation":[{"name":"School of Behavioral & Brain Sciences, Ponce Health Science University, Sala Ponce, 388 Calle Luis F, Ponce 00716, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael A.","family":"Torruella","sequence":"additional","affiliation":[{"name":"Intercambios Puerto Rico, #14 Antonio R. Barcel\u00f3, Esq. Calle Diego Zalduondo, Fajardo 00738, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Rom\u00e1n","family":"Badenas","sequence":"additional","affiliation":[{"name":"Intercambios Puerto Rico, #14 Antonio R. Barcel\u00f3, Esq. Calle Diego Zalduondo, Fajardo 00738, Puerto Rico"},{"name":"School of Behavioral & Brain Sciences, Ponce Health Science University, Sala Ponce, 388 Calle Luis F, Ponce 00716, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1016\/S0140-6736(14)61132-6","article-title":"The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations","volume":"384","author":"Fazel","year":"2014","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/maq.12665","article-title":"\u201cHousing is health care\u201d: Treating homelessness in safety-net hospitals","volume":"36","author":"Hanssmann","year":"2022","journal-title":"Med. Anthr. Q."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e2142685","DOI":"10.1001\/jamanetworkopen.2021.42685","article-title":"Overdose and homelessness\u2014Why we need to talk about housing","volume":"5","author":"Doran","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1001\/jamanetworkopen.2021.0477","article-title":"Addiction treatment retention and mortality among people experiencing homelessness","volume":"4","author":"Fine","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1111\/acps.12391","article-title":"Neurocognitive impairment in a large sample of homeless adults with mental illness","volume":"131","author":"Stergiopoulos","year":"2015","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_6","unstructured":"U.S. Department of Housing and Urban Development (2026, March 11). CoC Homeless Populations and Subpopulations Reports: Conteo de Personas Sin Hogar, Available online: https:\/\/files.hudexchange.info\/reports\/published\/CoC_Dash_CoC_PR-502-2022_PR_2022.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Ross, L.E., Vigod, S., and Wishart, J. (2015). Barriers and facilitators to primary care for people with mental health and\/or substance use issues: A qualitative study. BMC Fam. Pract., 16.","DOI":"10.1186\/s12875-015-0353-3"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1007\/s40263-019-00637-z","article-title":"Buprenorphine treatment for opioid use disorder: An overview","volume":"33","author":"Shulman","year":"2019","journal-title":"CNS Drugs"},{"key":"ref_9","first-page":"963","article-title":"The right to medication assisted treatment in jails and prisons","volume":"51","author":"Macomber","year":"2020","journal-title":"Univ. Memphis Law Rev."},{"key":"ref_10","unstructured":"Terry, N., Johnson, S., Larsen, J., and Burris, S. (2026, March 11). A Transformative Whole-of-Government Model to Reduce Opioid Use Harms and Deaths. SSRN. Available online: https:\/\/papers.ssrn.com\/sol3\/papers.cfm?abstract_id=4650698."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1007\/s11013-022-09807-z","article-title":"Harm reduction principles in a street medicine program: A qualitative study","volume":"47","author":"Frankeberger","year":"2022","journal-title":"Cult. Med. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e220117","DOI":"10.57264\/cer-2022-0117","article-title":"Protocol for the implementation of a statewide mobile addiction program","volume":"12","author":"Tschampl","year":"2023","journal-title":"J. Comp. Eff. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1007\/s10900-014-9897-8","article-title":"Satisfaction with healthcare services among free clinic patients","volume":"40","author":"Kamimura","year":"2015","journal-title":"J. Community Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1186\/s12939-023-01982-8","article-title":"Health care leaders\u2019 perspectives on the business impact of mobile health clinics","volume":"22","author":"Williams","year":"2023","journal-title":"Int. J. Equity Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1177\/1078390320916236","article-title":"Evaluating emergency department utilization for mobile mental health patients: A correlational retrospective analysis","volume":"27","author":"Weissinger","year":"2021","journal-title":"J. Am. Psychiatr. Nurses Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1111\/1468-0009.12582","article-title":"Social determinants of health influence future health care costs in the Medicaid cohort of the District of Columbia study","volume":"100","author":"McCarthy","year":"2022","journal-title":"Milbank Q."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/S0140-6736(17)31869-X","article-title":"Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: A systematic review and meta-analysis","volume":"391","author":"Aldridge","year":"2018","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/S1473-3099(16)30325-5","article-title":"Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: Findings from the global burden of disease study 2013","volume":"16","author":"Degenhardt","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_19","first-page":"82","article-title":"Prevalence and risk factors associated with homelessness among drug users in Puerto Rico","volume":"38","author":"Reyes","year":"2019","journal-title":"P. R. Health Sci. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.2105\/AJPH.2009.180109","article-title":"The unmet health care needs of homeless adults: A national study","volume":"100","author":"Baggett","year":"2010","journal-title":"Am. J. Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1016\/S0140-6736(14)61133-8","article-title":"Health interventions for people who are homeless","volume":"384","author":"Hwang","year":"2014","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1353\/hpu.2011.0025","article-title":"Street medicine: An example of reality-based health care","volume":"22","author":"Withers","year":"2011","journal-title":"J. Health Care Poor Underserved"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1370\/afm.2639","article-title":"House calls without walls: Street medicine delivers primary care to unsheltered persons experiencing homelessness","volume":"19","author":"Stefanowicz","year":"2021","journal-title":"Ann. Fam. Med."},{"key":"ref_24","unstructured":"Feldman, B.J., Feldman, C.T., Kogan, A.C., Saluja, S., and Cousineau, M. (2023). Street Medicine Landscape Survey Report, California Health Care Foundation. Available online: https:\/\/www.chcf.org\/wp-content\/uploads\/2023\/03\/CAStreetMedLandscapeSurveyReport.pdf."},{"key":"ref_25","unstructured":"Puerto Rico Mental Health and Anti-Addiction Services Administration (ASSMCA) (2026, March 11). Need Assessment Study of Mental Health and Substance Use Disorders and Service Utilization Among the Adult Population of Puerto Rico, Available online: https:\/\/www.docs.pr.gov\/files\/ASSMCA\/Estudios\/Need%20Assessment%20Study%20of%20Mental%20Health%20and%20Substance%20of%20Puerto%20Rico%202016.pdf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s00127-019-01653-6","article-title":"A comparison of the prevalence of psychiatric disorders in Puerto Rico with the United States and the Puerto Rican population of the United States","volume":"54","author":"Canino","year":"2019","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_27","unstructured":"(2026). Mobile Health Map at Harvard Medical School. Mobile Clinic Impact Tracker, Harvard Medical School. Available online: https:\/\/www.mobilehealthmap.org\/our-impact\/."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Oriol, N.E., Cote, P.J., Vavasis, A.P., Bennet, J., DeLorenzo, D., Blanc, P., and Kohane, I. (2009). Calculating the return on investment of mobile healthcare. BMC Med., 7.","DOI":"10.1186\/1741-7015-7-27"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1002\/wps.20457","article-title":"Estimating treatment coverage for people with substance use disorders: An analysis of data from the World Mental Health Surveys","volume":"16","author":"Degenhardt","year":"2017","journal-title":"World Psychiatry"},{"key":"ref_30","unstructured":"Truong, T.Q., Gandhi, D., Rosenthal, J., Johns, M., Rashid, M., Restrepo, D., Amaning, A., and Bluthenthal, C. (2023). Tackling the Opioid Crisis Requires a Whole-of-Government, Society-Wide Approach, Center for American Progress. Available online: https:\/\/www.americanprogress.org\/article\/tackling-the-opioid-crisis-requires-a-whole-of-government-society-wide-approach\/."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1186\/s12939-017-0671-2","article-title":"The scope and impact of mobile health clinics in the United States: A literature review","volume":"16","author":"Yu","year":"2017","journal-title":"Int. J. Equity Health"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Regis, C., Gaeta, J.M., Mackin, S., Baggett, T.P., Quinlan, J., and Taveras, E.M. (2020). Community care in reach: Mobilizing harm reduction and addiction treatment services for vulnerable populations. Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.00501"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Kaufman, R.A., Mallick, M., Louis, J.T., Williams, M., and Oriol, N. (2024). The Role of Street Medicine and Mobile Clinics for Persons Experiencing Homelessness: A Scoping Review. Int. J. Environ. Res. Public Heal., 21.","DOI":"10.3390\/ijerph21060760"},{"key":"ref_34","first-page":"36","article-title":"The Emerging Business Models and Value Proposition of Mobile Health Clinics","volume":"3","author":"Aung","year":"2015","journal-title":"Am. J. Accountable Care"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/4\/529\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T04:17:35Z","timestamp":1776745055000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/4\/529"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,18]]},"references-count":34,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["ijerph23040529"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23040529","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,18]]}}}