Farm workers are what comes to mind when most people think of migrant workers. However, migrant workers-somewhere between 20-25 million of them in the United States-are a diverse population that includes construction workers, workers in the restaurant and hospitality industry, and many other workers who frequently move in search of employment opportunities. Most, although not all, of these jobs are low paying and do not provide benefits
 ,like health coverage.

Such mobility can present many challenges-learning to negotiate new communities, ensuring consistent schooling for children, and maintaining the continuity of health care, especially for chronic conditions. Migrant workers are not necessarily immigrants, although many are. These individuals may face both language barriers and the challenge of functioning in a foreign culture.

The Migrant Clinicians Network's (MCN) goal is to improve health care for migrants by providing support, technical assistance, and professional development to clinicians in Federally Qualified Health Centers (FQHCs) and other health care sites.  In addition, MCN provides critical tools that allow clinicians to effectively serve this population.

Maintaining the continuity of care is perhaps the greatest challenge when working with migrants-how do you retain a patient who may only live in your community for 3-4 months? Subsequent providers may have no idea of the care previously provided due to a lack of access to medical records. This can result in either redundancy or a complete breakdown in care.

To address this challenge, MCN developed the Health Network.  The Health Network assures continuity of care and treatment completion by providing comprehensive case management, medical records transfer, and follow up services for mobile patients. It is an easily modifiable patient navigation system with application in disease surveillance and treatment management. At the center of the Health Network model is the case manager, who retain all patient records in a database. Encrypted medical records are sent electronically to new providers. The Network has been successful in managing patients as they move around the United States and even internationally.

The Health Network is ideal for chronic conditions, such as cancer, diabetes, tuberculosis, and HIV. It is also used to serve pregnant women who move during their pregnancy. In 2012, over 1,100 patients were enrolled in the Health Network and there were over 22,000 encounters between clinics and patients. Patients were followed in 45 states and 63 countries. The results speak for themselves. For example, 84 percent of tuberculosis patients completed their treatment-just slightly below the national rate of 88 percent.

The Health Network helps facilitate access to care for patients. They maintain a relationship with their MCN case manager as they move from community to community. As they build a relationship with new providers they always have access to their trusted case manager. The case manager also identifies providers in each new community so the patient does not need to figure out where they should go for care and worry about things like eligibility.

Ryan White grantees with mobile patients are eligible to use MCN's Health Network. MCN is already working with Ryan White grantees in New Jersey and the NO/AIDS Task Force in New Orleans.

For more information on MCN | http://www.migrantclinician.org

Winston, S.E., Montague, B.T., Lopez, M.J. et al. Evaluation of longitudinal clinical outcomes and adherence to care among HIV-infected refugees. Journal of the International Association of Providers of AIDS Care 2013, 12(3): 202-207.