New Mexico Mobile Screening Program for Miners
- Need: To increase access to medical screening for miners in New Mexico.
- Intervention: A mobile screening clinic with telemedicine capability screens miners for respiratory and other conditions.
- Results: In a recent survey, 92% of miners reported their care as very good, while the other 8% reported it as good. Since 1989, the program has served 6,685 miners.
Effective (About evidence-level criteria)
Most parts of New Mexico are designated as Health Professional Shortage Areas (HPSAs). Miners in New Mexico have higher rates of hypertension (39%) and diabetes (16%) compared to the rest of the state's population, with age-adjusted rates of 27% and 10%, respectively. This mining population, which is 37% Hispanic and 33% American Indian, is also at risk for pulmonary conditions such as pneumoconiosis, asthma, and chronic obstructive pulmonary disease (COPD) and tends to live in remote areas.
Started in 1989 by Miners' Colfax Medical Center in rural Raton, New Mexico, and the University of New Mexico Health Sciences Center in Albuquerque, the New Mexico Mobile Screening Program for Miners screens miners for respiratory and other health conditions, provides self-management information, and makes follow-up calls three months after a miner's visit. The program builds upon the National Institute for Occupational Safety and Health (NIOSH) mobile screening clinics used to improve healthcare access for miners.
A screening clinic is equipped with an advanced digital communication system for telemedicine and is located in a trailer specially outfitted to contain:
- Digital chest x-ray unit
- Examination room
- Patient reception area
- Sound-proof audiometry booth
- Spirometry room
Each clinic staffs:
- Physician assistant or nurse practitioner
- Medical assistant/nurse technician, NIOSH-certified for spirometry
- Radiology/audiometry technician
- Program manager, if needed for more heavily attended clinics
The New Mexico Mobile Screening Program for Miners is funded by a Health Resources and Services Administration (HRSA) Black Lung Clinics Grant.
After completing a form detailing their clinical and occupational history, miners are screened for the following conditions and disorders:
- Hearing loss
The clinics also perform a complete history and physical examination and then assess a miner's risk factors for:
- Cardiovascular disease
- Exposure to smoke
- Obstructive sleep apnea
- Substance use
Screening providers can recommend that miners see a pulmonary specialist. These meetings are scheduled for the same afternoon and conducted via telemedicine. Telemedicine offers miners access to specialist care from the University of New Mexico Health Sciences Center, and the service offers screening providers a chance to consult with these specialists.
In most cases, miners' insurance covers the screening visit; if the insurance does not, a miner is not billed for services. Miners are encouraged to get re-screened every three years. Program coordinators contact miners via mail with information about re-screening.
In a convenience-sample survey, all miners reported their care as good (8%) or very good (92%), and 100% would recommend the mobile screening clinic to others. The average return rate of visitors to clinics held in 2015-2016 is 45%.
In addition, the program has been able to expand from New Mexico to Kemmerer, Wyoming.
For more information:
Evans, K., Lerch, S., Boyce, T.W., Myers, O.B., Kocher, E., Cook, L.S., & Sood, A. (2016). An Innovative Approach to Enhancing Access to Medical Screening for Miners using a Mobile Clinic with Telemedicine Capability. Journal of Health Care for the Poor and Underserved, 27(4), 62-72. Article Abstract
Program coordinators advertised upcoming clinics through radio, newspapers, and flyers but found that person-to-person communication works best: 50% of the surveyed miners reported hearing about the clinics from a friend or relative.
The majority of miners who are screened do not seek post-screening medical care. Program coordinators recommend that similar mobile clinics devote time and resources to post-screening case management.
Program coordinators are able to sustain the clinics because the vast majority of participants have insurance that covers screening and that New Mexico's Medicaid program covers telemedicine. Depending on their state and population, similar programs may experience different levels of sustainability.
Akshay Sood, MD, MPH, Tenured Professor and Miners' Colfax Medical Center Endowed Chair for Mining-Related Lung Diseases
University of New Mexico School of Medicine
Chronic respiratory conditions
Mobile and episodic healthcare delivery
Occupational health and safety
December 1, 2016
December 5, 2017
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