Association Between Mobile Health Clinic Use, Care Coordination, and Continuity in Rural Areas: A Survey Study in Taiwan

Background: Driven by geography-related factors, rural populations can experience health care access barriers and fragmented care marked by a lack of continuity and coordination of care. In Taiwan, mobile health clinics (MHC) have been utilized to improve access by reducing geographic distance and delivering primary care services directly to patients in rural regions, potentially improving care coordination and continuity. To examine the association between rural MHCs and health care access, care coordination, and continuity. Methods: A cross-sectional phone interview survey was conducted in June 2022 among 1,995 rural adult residents randomly selected via a stratified random sampling approach. The study exposure variable was rural mobile health clinic (MHC) use. Study outcomes included one measure of health care access barriers, one measure of continuity, and five measures of care coordination. Associations were assessed using multivariate logit regression, controlled for geographic region and patient characteristics, with marginal effects estimated using delta method precision measures. Results: Rural MHC use was not associated with health care access barriers (missing needed care). In contrast, rural MHC use was positively associated with greater likelihood of continuity (having a usual physician; 11.8 percentage-points, p < .001), as well as four measures of care coordination: physicians asking about other physician visits the patient had elsewhere (15.7 percentage-points, p < .001), communication with other physicians (8.2 percentage-points, p < 0.05), discussion of medical conditions with other physicians (3.7 percentage-points, p < 0.05), and working together with other physicians (6.9 percentage-points, p < .005). Conclusions: Rural MHC use is associated with greater continuity and care coordination, suggesting that it may be a viable strategy to promote continuity and coordination in rural settings.