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)

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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?

0

10

20

30

40

50

60

70

0 1 2 3 4 5 6 7 8 9 10 11 12 >12Number of surgeries per week

Perc

ent (

%)

ampm/eveningtotal

9

Organisation3. What is the booking interval for routine appointments?

0%

10%

20%

30%

40%

50%

60%

70%

5 7 10 15 variableminutes

Perc

ent (

%)

3% 1%

26%

4%

66%(n=119)

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Organisation10. Is the prison ‘paper light’ (clinical information is entered directly

onto computer)?

Q10n 120

yes 11no 109

yes9%

no91%

If yes, does this apply to- medical notes 13investigations 6

letters 6

11

0% 20% 40% 60% 80% 100%

If No, would this be helpful?

3. If a prisoner is transferred to your prison from another prison, does that prison send you the prisoner’s medical records?

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?

1. Is there a system in place to ensure that a prisoner’s general practice medical records are transferred from the community to your healthcare facility?

Percent (%)

n

121

75

121

2

118

8YesNo

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Admin/other/unclearHealthcare manager/officer

NurseCPN/RMN

Health care assistant

Pharmacist/assistant/technicianDentist/dental hygienist/assistant

GP/unspecified doctor

Counselling/clinical psychologistCounsellor various

Art/drama/music/activity therapist/coordinator

0 10 20 30 40 50 60 70 80 90Number of prisons

Staff vacancies

13

Section 2: Chronic Diseases

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Chronic diseasesDoes the prison have a register of patients with…?

109

72

102

82

13

49

19

38

0%

20%

40%

60%

80%

100%

Diabetes IHD Asthma Hepatitis

no

yes

Per

cen

t (%

)

15

Chronic diseases1. If yes, is the register electronic?

0%

20%

40%

60%

80%

100%

Diabetes IHD Asthma Hepatitis

no

yes

Per

cen

t (%

)

34 23 3623

77 49 6460

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Chronic diseases3. Does the prison have a recall system for …?

0%

20%

40%

60%

80%

100%

Diabetes IHD Asthma Hepatitis

no

yes

Per

cen

t (%

)

89

47

77 78

31

73

43 36

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Chronic diseases6. Does the prison provide sessions held by a specialist nurse

trained in the care of …?

0%

20%

40%

60%

80%

100%

Diabetes IHD Asthma Hepatitis

no

yes

Per

cen

t (%

)

73

20

60 61

45

98

60 54

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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?

no32%

yes68%

yes77%

no23%

Psychologist0

102030405060

CounsellorCPN Other

UnknownPe

rcen

t (%

)

SoleCombined

If yes, who provides the talk therapy?

q2 n 119yes 92no 27

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Exploratory Analysis

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Stratifying variables for exploratory analysis

• Category of prison: Cat A/B if category A/B prisoners present

• Women’s prison: If prisons identified themselves as such (15)

• Large prison: >500

• Level of health care support: GP sessions/week/prisoner. High level if >0.02

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Relationship between stratifying variables

Correlations

1 .249** .185.008 .058

122 113 105-.234** -.324** .373**.009 .000 .000122 113 105.249** 1 -.287**.008 .005113 113 96.185 -.287** 1.058 .005105 96 105

Pearson CorrelationSig. (2-tailed)NPearson CorrelationSig. (2-tailed)NPearson CorrelationSig. (2-tailed)NPearson CorrelationSig. (2-tailed)N

Category A or B prison

Women's prison

Prison popn. >500

GP sessions /week/prisoner > 0.02

Category Aor B prison

Prisonpopn >500

GP sessions/week

> 0.02

Correlation is significant at the 0.01 level (2-tailed).**.

-.234**.009122

1

122-.324**.000113.373**.000105

Women'sprison

/prisoner

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Question Percent (%) χ2, 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% <.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% <.001 100%* Large prison 60.9% vs. 41.8% .046 92.6%* High GP attendance 66.7% vs. 46.4% .097 86.1%

OrganisationSpecialist services

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Question Percent (%) χ2, p Valid (%)

Methadone maintenance 35%* Cat A/B prison 51.1% vs. 26% .005 100%* Women's prison 86.7% vs 28% <.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%

OrganisationSpecialist services

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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

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Discussion

• What is expected, what is unexpected?

• The association of category of prisoner and provision of services: is it justifiable?

• What needs investigating further?

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The End