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Secondary care clinicians and staff have a key role in delivering equivalence of care for prisoners: A qualitative study of prisoners’ experiences

ABSTRACT: Background: While challenging to provide, prisoners are entitled to healthcare equivalent to community patients. This typically involves them travelling to hospitals for secondary care, whilst adhering to the prison's operational security constraints. Better understanding of equivalence issues this raises may help hospitals and prisons consider how to make services more inclusive and accessible to prisoners. We used prisoners’ accounts of secondary care experiences to understand how these relate to the principle of healthcare equivalence. Methods: We undertook a qualitative interview (n?=?17) and focus group (n?=?5) study in the English prison estate. Prisoners who had visited acute hospitals for consultations were eligible for participation. They were recruited by peer researchers. 45 people (21 female, 24 male, average age 41) took part across five prisons. Participants were purposively recruited for diversity in gender, age and ethnicity. Findings: Experiences of hospital healthcare were analysed for themes relating to the principle of ‘equivalence of care’ using Framework Analysis. Participants described five experiences challenging ‘equivalence of care’ for prisoners: (1) Security overriding healthcare need or experience (2) Security creating public humiliation and fear (3) Difficulties relating to prison officer's role in medical consultations (4) Delayed access due to prison regime and transport requirements and (5) Patient autonomy restricted in management of their own healthcare. Interpretation: Achieving equivalence of care for prisoners is undermined by fear, stigma, reduced autonomy and security requirements. It requires co-ordinated action from commissioners, managers, and providers of prison and healthcare systems to address these barriers. There is a need for frontline prison and healthcare staff to address stigma and ensure they understand common issues faced by prisoners seeking to access healthcare, while developing strategies which empower the autonomy of prisoners’ healthcare decisions.

SUBMITTER: Edge C

PROVIDER: S-EPMC7525130 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Transitions of care are often risky, particularly for older people, and shorter hospital stays mean that patients can go home with ongoing care needs. Most previous research has focused on fundamental system flaws, however, care generally goes right far more often than it goes wrong. We explored staff perceptions of how high performing general practice and hospital specialty teams deliver safe transitional care to older people as they transition from hospital to home. METHODS:We conducted a qualitative study in six general practices and four hospital specialties that demonstrated exceptionally low or reducing readmission rates over time. Data were also collected across four community teams that worked into or with these high-performing teams. In total, 157 multidisciplinary staff participated in semi-structured focus groups or interviews and 9 meetings relating to discharge were observed. A pen portrait approach was used to explore how teams across a variety of different contexts support successful transitions and overcome challenges faced in their daily roles. RESULTS:Across healthcare contexts, staff perceived three key themes to facilitate safe transitions of care: knowing the patient, knowing each other, and bridging gaps in the system. Transitions appeared to be safest when all three themes were in place. However, staff faced various challenges in doing these three things particularly when crossing boundaries between settings. Due to pressures and constraints, staff generally felt they were only able to attempt to overcome these challenges when delivering care to patients with particularly complex transitional care needs. CONCLUSIONS:It is hypothesised that exceptionally safe transitions of care may be delivered to patients who have particularly complex health and/or social care needs. In these situations, staff attempt to know the patient, they exploit existing relationships across care settings, and act to bridge gaps in the system. Systematically reinforcing such enablers may improve the delivery of safe transitional care to a wider range of patients. TRIAL REGISTRATION:The study was registered on the UK Clinical Research Network Study Portfolio (references 35272 and 36174 ).

Project description:BackgroundWith more patients in need of oncological care, there is a growing interest to transfer survivorship care from specialist to general practitioner (GP). The ongoing I CARE study was initiated in 2015 in the Netherlands to compare (usual) surgeon- to GP-led survivorship care, with or without access to a supporting eHealth application (Oncokompas).MethodsSemi-structured interviews were held at two separate points in time (i.e. after 1- and 5-years of care) to explore GPs' experiences with delivering this survivorship care intervention, and study its implementation into daily practice. Purposive sampling was used to recruit 17 GPs. Normalisation Process Theory (NPT) was used as a conceptual framework.ResultsOverall, delivering survivorship care was not deemed difficult and dealing with cancer repercussions was already considered part of a GPs' work. Though GPs readily identified advantages for patients, caregivers and society, differences were seen in GPs' commitment to the intervention and whether it felt right for them to be involved. Patients' initiative with respect to planning, absence of symptoms and regular check-ups due to other chronic care were considered to facilitate the delivery of care. Prominent barriers included GPs' lack of experience and routine, but also lack of clarity regarding roles and responsibilities for organising care. Need for a monitoring system was often mentioned to reduce the risk of non-compliance. GPs were reticent about a possible future transfer of survivorship care towards primary care due to increases in workload and financial constraints. GPs were not aware of their patients' use of eHealth.ConclusionsGPs' opinions and beliefs about a possible future role in colon cancer survivorship care vary. Though GPs recognize potential benefit, there is no consensus about transferring survivorship care to primary care on a permanent basis. Barriers and facilitators to implementation highlight the importance of both personal and system level factors. Conditions are put forth relating to time, reorganisation of infrastructure, extra personnel and financial compensation.Trial registrationNetherlands Trial Register; NTR4860 . Registered on the 2nd of October 2014.

Project description:BackgroundInsomnia is very common, especially among psychiatric patients in secondary care. It is experienced as a 24 h problem affecting several domains of life. Cognitive behavioural therapy for insomnia (CBT-I) is widely regarded as the first-line treatment and often improves comorbid disorders. Despite this, many patients are not offered CBT-I. Internet based CBT for insomnia (iCBT-I) is just as effective as face-to-face treatments and could considerably increase availability. However, it is unclear whether iCBT-I is suitable for patients with more severe and comorbid psychiatric illnesses in secondary care.MethodsEleven Swedish participants (24-68 years old) in outpatient secondary psychiatric care who underwent iCBT-I treatment were interviewed. The semi-structured interviews were analysed using content analysis. The purpose was to map their experiences, motivation and suggestions for improvement.ResultsPrior to the treatment, most participants were highly motivated to take the opportunity to address their insomnia. The treatment was perceived as well-structured and interesting. The most difficult aspect was counteracting the fatigue. It was also hard to continue the treatment when faced with major life events. During this phase, contact with the therapist motivated them to continue the treatment. Several desired more face-to-face meetings. It was also motivating to gain insights into and a sense of control over sleep. Several described better sleep, improved daily routines, a more predictable everyday life and increased energy. Daytime well-being was improved in some, partly because they had more energy but also because they filled their days with more activities.ConclusionThe treatment has the potential to be very useful in secondary psychiatric care where insomnia is common and affects comorbid disorders. Psychiatric patients might have more difficulties continuing with iCBT-I treatment, but those who manage to complete the program have a good chance of obtaining benefit. Extensive psychological groundwork early in treatment is likely to pay off later when motivation is needed. Additional social support and other adjustments may also enhance treatment outcomes. Participants' stories are particularly valuable, as therapists and treatment developers receive less feedback from patients in internet-based treatments compared to face-to-face treatments.

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Secondary care clinicians and staff have a key role in delivering equivalence of care for prisoners: A qualitative study of prisoners’ experiences

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