PRISON PRIMARY HEALTH CARE SURVEY

1
PRISON PRIMARY HEALTH CARE SURVEY

• Charles Cornford, Bonnie Sibbald, Katie Buchanan,
  James Mason, Lenny Baer, Helen Thornton-Jones,
  Mark Williamson

2
Introduction

• Concerns about the standard of primary care
  services in prisons
• Debates about the normalisation of care
  provision
• Chronic disease management current NHS priority

3
Background

• Known problems
• The particular patient group
• Prison setting
• High turnover
• Opportunities
• Cervical smear uptake
• Diabetes
• Hepatitis C

4
Aims

• To describe the organisation of primary health
  care services in prisons
• To describe the organisation of health care
  services for common chronic illnesses (diabetes,
  IHD, hepatitis, asthma)
• To make comparisons between different types of
  prison

5
Method

• Survey of all prisons England and Wales
• Questionnaire design
• Posted to governors and returned to the DH
• Reminders one postal, several telephone
• Data input into SSPS
• Statistical analysis (descriptive and
  multivariate)

6
Response

• Questionnaire sent to 138 prisons
• 124 Prisons responded of which 2 too late to be
  included
• Response rate 122 from 138 (87)

7
Section 1 Organisation
8
Organisation1. How many morning surgeries are
offered each week? 2. How many
afternoon/evenings surgeries are offered each
week?
9
Organisation3. What is the booking interval for
routine appointments?
70
(n119)
66
60
50
40
Percent ()
30
26
20
10
4
3
1
0
5
7
10
15
variable
minutes
10
Organisation10. Is the prison paper light
(clinical information is entered directly onto
computer)?
Q10
n 120
yes 11
no 109
yes
no
9
91
If yes, does this apply to-
medical notes 13
investigations 6
letters 6


11
n
121
75
121
2
118
8
1. Is there a system in place to ensure that a
prisoners general practice medical records are
transferred from the community to your healthcare
facility?
If No, are you planning to introduce such a
system in the next year?
2. If a prisoner is transferred from your prison
to another, do you have a system in place to
ensure that your medical records for that
prisoner are forwarded?
If No, are you planning to introduce such a
system in the next year?
3. If a prisoner is transferred to your prison
from another prison, does that prison send you
the prisoners medical records?
If No, would this be helpful?
0
20
40
60
80
100
Percent ()
12
Staff vacancies
Number of prisons
0
10
20
30
40
50
60
70
80
90
Admin/other/unclear
Healthcare manager/officer
Nurse
CPN/RMN




Health care assistant






Pharmacist/assistant/technician
Dentist/dental hygienist/assistant
GP/unspecified doctor


Counselling/clinical psychologist
Counsellor various
Art/drama/music/activity therapist/coordinator
13
Section 2 Chronic Diseases
14
Chronic diseasesDoes the prison have a register
of patients with?
100
13
no
19
38
yes
80
49
60
Percent ()
109
102
40
82
72
20
0
Diabetes
IHD
Asthma
Hepatitis
15
Chronic diseases1. If yes, is the register
electronic?
100
no
yes
80
64
49
77
60
60
Percent ()
40
20
36
23
34
23
0
Diabetes
IHD
Asthma
Hepatitis
16
Chronic diseases3. Does the prison have a recall
system for ?
100
no
31
36
yes
43
80
73
60
Percent ()
40
89
78
77
20
47
0
Diabetes
IHD
Asthma
Hepatitis
17
Chronic diseases6. Does the prison provide
sessions held by a specialist nurse trained in
the care of ?
100
no
yes
45
80
54
60
60
98
Percent ()
40
73
61
60
20
20
0
Diabetes
IHD
Asthma
Hepatitis
18
Chronic diseases1. Does the prison provide talk
therapies (e.g. cognitive behaviour therapy)
for patients with anxiety or depression?
2. Does the prison provide self help material for
prisoners with anxiety and depression?
q2  
n 119
yes 92
no 27
19
Exploratory Analysis
20
Stratifying variables for exploratory analysis

• Category of prison Cat A/B if category A/B
  prisoners present
• Womens prison If prisons identified themselves
  as such (15)
• Large prison gt500
• Level of health care support GP
  sessions/week/prisoner. High level if gt0.02

21
Relationship between stratifying variables
Correlations
GP sessions
/week
Category A
Prison
Women's
/prisoner
or B prison
popn gt500
gt 0.02
prison
Pearson Correlation
Category A or B prison
1
.249

.185
-.234

Sig. (2-tailed)
.008
.058
.009
N
122
113
105
122
Pearson Correlation
Women's prison
-.234

-.324

.373

1
Sig. (2-tailed)
.009
.000
.000
N
122
113
105
122
Pearson Correlation
Prison popn. gt500
.249

1
-.287

-.324

Sig. (2-tailed)
.008
.005
.000
N
113
113
96
113
Pearson Correlation
GP sessions /week
.185
-.287

1
.373

/prisoner gt 0.02
Sig. (2-tailed)
.058
.005
.000
N
105
96
105
105
.
Correlation is significant at the 0.01 level
(2-tailed).
22
OrganisationSpecialist services
Question Percent () ?2, p Valid ()
Mental health day care service 23
Cat A/B prison 35.6 vs 15.6 .015 100

Close supervision unit 13
Cat A/B prison 26.7 VS. 5.2 .001 100

Vulnerable prisoner unit/wing 31
Cat A/B prison 57.8 vs 15.6 lt.001 100
Women's prison 6.7 vs 34.6 .029 100
Large prison 45.7 vs 16.4 .001 92.6

Mental health in-reach team 87
Cat A/B prison 95.6 vs. 81.8 .030 100

Medically assisted detoxification 52
Cat A/B prison 80 vs. 35.1 lt.001 100
Large prison 60.9 vs. 41.8 .046 92.6
High GP attendance 66.7 vs. 46.4 .097 86.1
23
OrganisationSpecialist services
Question Percent () ?2, p Valid ()
Methadone maintenance 35
Cat A/B prison 51.1 vs. 26 .005 100
Women's prison 86.7 vs 28 lt.001 100
High GP attendance 47.6 vs. 27.4 .074 86.1

Dedicated drug detox unit/wing 24.6
Cat A/B prison 42.2 vs. 14.3 .001 100

Voluntary drug testing wing 53
Cat A/B prison 62.2 vs. 46.8 .099 100
Large prison 60.9 vs 41.8 .046 92.6

Substance misuse education courses 62.3
Cat A/B prison 73.3 vs 55.8 .054 100
24
Main findings

• Low use of IT
• Significant problems with recruitment/retention
• Gaps in delivery of services for chronic diseases
• Category A/B prisons are more likely to have a
  range of services

25
Discussion

• What is expected, what is unexpected?
• The association of category of prisoner and
  provision of services is it justifiable?
• What needs investigating further?

26
The End