The quality of prison primary care: cross-sectional analyses of prison healthcare data in Northern England

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

Abstract

Background Prisoners have considerable health needs, are relatively high users of health care and often die prematurely. Prison healthcare research has typically focused on specific problems such as substance misuse, but ‘routine’ primary care has received less attention. Strong primary care systems are associated with better population outcomes. Identifying inappropriate variations in care will inform strategies to close gaps in health care and reduce preventable deaths.

Aim To explore variations in the quality of primary care for prisoners.

Method We assessed achievement against 30 quality indicators examining different aspects of care in 13 prisons. We conducted repeated cross-sectional analyses of routinely recorded data from electronic health records across 2017–2020. Multi-level logistic regression models explored associations between indicator achievement and prison and prisoner characteristics.

Results We found marked variations in achievement between different indicators and different 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, in 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, from 1·93-fold for prescribing of gabapentinoids with no coded diagnosis of neuropathic pain (Odds Ratio (OR) range 0·67 to 1·29) to 21,610-fold for medicine reconciliation (OR range 0·45 to 9724·5). Shorter lengths of stay were frequently associated with lower achievement. Some associations between ethnicity and achievement were identified.

Conclusion 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, March). The quality of prison primary care: cross-sectional analyses of prison healthcare data in Northern England. Presented at BJGP Research Conference

• Presentation Conference Type: Speech
• Conference Name: BJGP Research Conference
• Start Date: Mar 31, 2023
• End Date: Mar 31, 2023
• Deposit Date: Dec 4, 2023
• Publisher: Royal College of General Practitioners
• DOI: https://doi.org/10.3399/bjgp23X733761