Consider a patient treated for diabetes during harvest who expects to move before the next appointment. The care team needs a plan for records, medication access, and a handoff to a clinic near the next work site.
Chronic disease care for migratory farmworkers works when it is designed for movement. That means finishing as much as possible in one visit, giving the patient a usable record and medication plan, and arranging care at the next destination before the patient leaves. A mobile clinic supports the first two steps. The third takes a deliberate workflow.
Chronic conditions are common and often untreated
About half of hired crop workers (51%) have been told by a clinician that they have a chronic condition, according to a KFF analysis of the 2022 National Agricultural Workers Survey. That count only includes people who were diagnosed. The same survey found 53% uninsured and 21% unable to get needed care in the past year, so many conditions likely go undiagnosed.
The burden varies by region. A study of NAWS data from 2013 to 2016 found diabetes prevalence among farmworkers in the Southwest (114.2 per 1,000) was nearly double that in other regions. Hypertension rates were similar across regions after adjusting for age, income, and insurance.
Agricultural worker patients include people who stay in one area and people who move with seasonal work. A program needs a plan for both: steady follow-up for the people who stay, and a bridge for the people who move.
Finish more in one visit
The best defense against a lost follow-up is completing more services during each visit. From 1998 to 2003, migrant health programs in Minnesota and North Dakota ran evening diabetes cluster clinics that combined services patients would otherwise need separate visits to receive. Those were fixed-site clinics; a mobile program can adapt the scheduling idea.
- Point-of-care testing. A1C, glucose, and lipid results during the visit let the clinician adjust treatment before the patient leaves. Our post on point-of-care testing and CLIA waivers on a mobile clinic covers the setup.
- Bundled services. Blood pressure check, foot exam, eye screening, vaccines, and diabetes education in one stop.
- Telehealth for specialists. An endocrinologist or behavioral health clinician can join the visit remotely when the program has the necessary clinical and technology support.
Put the record and the medication in the patient's hands
When a patient may be gone by the next appointment, the visit has to end with what he needs to keep going.
- A portable record. A printed visit summary in the patient's language, with diagnoses, current medications and doses, recent lab values, and allergies. Some programs use wallet cards. The next clinician, in another state, can act on it without a records request.
- A medication plan for the move. The clinician and pharmacy team should determine a clinically appropriate supply, confirm coverage and dispensing rules, and identify how the patient can obtain refills at the next destination. Sliding-fee and 340B arrangements vary by program and do not automatically fund a long supply.
- Clear instructions. What to do if sugar runs high or low, what the medication is for, and when to see a clinician, explained in the patient's language and checked with teach-back.
Hand off before the patient leaves
Ask every patient with a chronic condition, at every visit, where he expects to be working next and when. Then link him to care there.
Migrant Clinicians Network's Health Network does this work as a service. A health center enrolls a patient who is moving before treatment is complete. Health Network staff then find a clinic at the next destination, set up appointments, transfer records, and help with sliding fee enrollment and transportation. The program has served thousands of patients since 1995, including farmworkers moving with the seasons, and covers diabetes, hypertension, cancer, pregnancy, tuberculosis, and other conditions.
Programs can also build their own links with health centers along common migration routes. A care coordinator who knows the outreach director at the health center in the next state can make a warm handoff in a phone call.
Keep the same team on the route
Continuity also depends on the people. A patient who sees the same nurse practitioner and medical assistant through the season can build a relationship with the team. A dedicated mobile crew provides that consistency and protects the route when a fixed site is short-staffed.
Dental and vision belong in the plan
Chronic disease care extends beyond medication. Dental and vision services may reveal needs that a medical-only visit cannot address. Programs can consider mobile dental or vision days if local needs, staffing, and funding support them.
The farmworker mobile health hub connects to the rest of this series, and Mission Mobile Medical's guide to how to start a mobile health clinic covers the full planning process.
Quick answers
How do mobile clinics keep care going when farmworkers move?
They complete as much as possible in one visit, give patients a portable record and a clinically appropriate medication plan, and link patients to a clinic at their next destination before they leave.
What is Migrant Clinicians Network's Health Network?
Health Network is a virtual case management program for patients who move before treatment is complete. It finds care at the next destination, sets appointments, and transfers records.
Is diabetes common among farmworkers?
It is common in some regions. A study of national farmworker survey data found diabetes prevalence among Southwest farmworkers nearly double that of farmworkers elsewhere.
Mission Mobile Medical's planning and staffing advisors help health centers build chronic care workflows that travel with their patients.