Moschetti Karine, Zabrodina Véra, Stadelmann Pierre, Wangmo Tenzin, Holly Alberto, Wasserfallen Jean-Blaise, Elger Bernice S, Gravier Bruno
Institute of Social and Preventive Medicine, University of Lausanne and University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Technology Assessment Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
PLoS One. 2017 Oct 30;12(10):e0187255. doi: 10.1371/journal.pone.0187255. eCollection 2017.
Prison healthcare is an important public health concern given the increasing healthcare needs of a growing and aging prison population, which accumulates vulnerability factors and suffers from higher disease prevalence than the general population. This study identifies the key factors associated with outpatient general practitioner (GP), nursing or psychiatric healthcare utilization (HCU) within prisons. Cross-sectional data systematically collected by the prison medical staff were obtained for a sample of 1664 adult prisoners of the Canton of Vaud, Switzerland, for the year 2011. They contain detailed information on demographics (predisposing factors), diagnosed chronic somatic and psychiatric disorders (needs factors), as well as prison stay characteristics (contextual factors). For GP, nurse and psychiatric care, two-part regressions are used to model separately the probability and the volume of HCU. Predisposing factors are generally not associated with the probability to use healthcare services after controlling for needs factors. However, female inmates use higher volumes of care, and the volume of GP consultations increases with age. Chronic somatic and psychiatric conditions are the most important predictors of the probability of HCU, but associations with volumes differ in their magnitude and significance across disease groups. Infectious, musculoskeletal, nervous and circulatory diseases actively mobilize GP and nursing staff. Schizophrenia, illicit drug and pharmaceuticals abuse are strongly positively associated with psychiatric and nurse HCU. The occupancy rate displays positive associations among contextual factors. Prison healthcare systems face increasingly complex organizational, budgetary and ethical challenges. This study provides relevant insights into the HCU patterns of a marginalized and understudied population.
鉴于监狱人口不断增长且老龄化，其医疗保健需求日益增加，监狱医疗保健成为一个重要的公共卫生问题。监狱人口积累了各种脆弱因素，疾病患病率高于普通人群。本研究确定了与监狱门诊全科医生（GP）、护理或精神科医疗保健利用（HCU）相关的关键因素。我们获取了瑞士沃州监狱医务人员系统收集的1664名成年囚犯在2011年的横断面数据。这些数据包含有关人口统计学（ predisposing因素）、已诊断的慢性躯体和精神疾病（需求因素）以及监禁时间特征（背景因素）的详细信息。对于全科医生、护士和精神科护理，采用两部分回归分别对医疗保健利用的概率和数量进行建模。在控制需求因素后， predisposing因素通常与使用医疗服务的概率无关。然而，女性囚犯使用的护理量更高，全科医生会诊量随年龄增长而增加。慢性躯体和精神疾病是医疗保健利用概率的最重要预测因素，但不同疾病组在数量上的关联在幅度和显著性方面存在差异。传染病、肌肉骨骼疾病、神经系统疾病和循环系统疾病会积极调动全科医生和护理人员。精神分裂症、非法药物和药物滥用与精神科和护理医疗保健利用呈强烈正相关。入住率在背景因素中显示出正相关。监狱医疗保健系统面临着日益复杂的组织、预算和伦理挑战。本研究为一个边缘化且研究不足的人群的医疗保健利用模式提供了相关见解。
