The quality of prison primary care: cross-sectional cluster-level analyses of prison healthcare data in the North of England

McLintock, Kate; Foy, Robbie; Canvin, Krysia; Bellass, Sue; Hearty, Philippa; Wright, Nat; Cunningham, Marie; Seanor, Nicola; Sheard, Laura; Farragher, Tracey

Abstract

Background: Prisoners have significant health needs, are relatively high users of healthcare and often die prematurely. Strong primary care systems are associated with better population health outcomes. We investigated the quality of primary care delivered to prisoners.

Methods: We assessed achievement against 30 quality indicators spanning different domains of care in 13 prisons in the North of England. We conducted repeated cross-sectional analyses of routinely recorded data from electronic health records over 2017-20. Multi-level mixed effects logistic regression models explored associations between indicator achievement and prison and prisoner characteristics.

Findings: We found marked variations in achievement between indicators and between prisons. Achievement ranged from 0·2% of people with epilepsy coded as seizure-free to 93·8% of people with diabetes having blood pressure checks over the preceding year. Achievement improved over three years for 11 indicators and worsened for six, including declining antipsychotic monitoring and rising opioid prescribing. Achievement varied between prisons, e.g. 1·93-fold for gabapentinoid prescribing without coded neuropathic pain (odds ratio [OR] range 0·67 to 1·29) and 169-fold for dried blood spot testing (OR range 0·05 to 8·45). Shorter lengths of stay were frequently associated with lower achievement. Ethnicity was associated with some indicators achievement, although the associations differed with indicators.

Interpretation: We found substantial scope for improvement and marked variations in quality, which were largely unaltered after adjustment for prison and prisoner characteristics.

Citation

McLintock, K., Foy, R., Canvin, K., Bellass, S., Hearty, P., Wright, N., …Farragher, T. (2023). The quality of prison primary care: cross-sectional cluster-level analyses of prison healthcare data in the North of England. EClinicalMedicine, 63, Article 102171. https://doi.org/10.2139/ssrn.4456608

• Journal Article Type: Article
• Acceptance Date: Aug 7, 2023
• Online Publication Date: Aug 31, 2023
• Publication Date: 2023-09
• Deposit Date: Dec 4, 2023
• Publicly Available Date: Dec 4, 2023
• Journal: eClinicalMedicine
• Print ISSN: 2589-5370
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 63
• Article Number: 102171
• DOI: https://doi.org/10.2139/ssrn.4456608
• Public URL: https://keele-repository.worktribe.com/output/655476
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S2589537023003486?via%3Dihub
• Related Public URLs: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4456608