Thomas Emily H, Wang Emily A, Curry Leslie A, Chen Peggy G
Department of Internal Medicine, University of California - San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, Building 10, 3rd Floor, Ward 13, San Francisco, CA 94110 USA.
Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208056, 333 Cedar Street, New Haven, CT 06520 USA.
Health Justice. 2016;4:4. doi: 10.1186/s40352-016-0035-9. Epub 2016 Apr 2.
Despite greater risk of cardiovascular disease (CVD) mortality in patients with a history of incarceration, little is known about how prisons manage CVD risk factors (CVD-RF) to mitigate this risk.
We conducted in-depth interviews with individuals with CVD-RF who had been recently released from prison ( = 26). These individuals were recruited through community flyers and a primary care clinic in Connecticut. Using a grounded theory approach and the constant comparative method, we inductively generated themes about CVD-RF care in prisons. Data collection and analysis occurred iteratively to refine and unify emerging themes.
Four themes emerged about care in prison: (1) Participants perceive that their CVD-RFs are managed through acute, rather than chronic, care processes; (2) Prison providers' multiple correctional and medical roles can undermine patient-centered care; (3) Informal support systems can enhance CVD-RF self-management education and skills; and (4) The trade-off between prisoner security and patient autonomy influences opportunities for self-management.
Patients develop self-management skills through complex processes that may be compromised by the influence of correctional policies on medical care. Our findings support interventions to engage peers, medical providers, care delivery systems, and correctional staff in cultivating effective self-management strategies tailored to prison settings.
尽管有监禁史的患者心血管疾病（CVD）死亡风险更高，但对于监狱如何管理心血管疾病风险因素（CVD-RF）以降低这种风险却知之甚少。
我们对最近刚从监狱释放的患有CVD-RF的个体（n = 26）进行了深入访谈。这些个体是通过社区传单和康涅狄格州的一家初级保健诊所招募的。我们采用扎根理论方法和持续比较法，归纳出关于监狱中CVD-RF护理的主题。数据收集和分析反复进行，以完善和统一新出现的主题。
出现了四个关于监狱护理的主题：（1）参与者认为他们的CVD-RF是通过急性护理而非慢性护理过程来管理的；（2）监狱医护人员的多种惩教和医疗角色可能会破坏以患者为中心的护理；（3）非正式支持系统可以加强CVD-RF自我管理教育和技能；（4）囚犯安全与患者自主权之间的权衡影响自我管理的机会。
患者通过复杂的过程培养自我管理技能，而这些过程可能会因惩教政策对医疗护理的影响而受到损害。我们的研究结果支持采取干预措施，让同伴、医疗提供者、护理提供系统和惩教人员参与制定适合监狱环境的有效自我管理策略。
