Quinn Cath, Denman Katie, Smithson Philippa, Owens Christabel, Sheaff Rod, Campbell John, Porter Ian, Annison Jill, Byng Richard
Plymouth University, Drake Circus, Plymouth, Devon, PL4 8AA, UK.
University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
BMC Fam Pract. 2018 Feb 2;19(1):22. doi: 10.1186/s12875-018-0708-7.
Offenders frequently have substantial healthcare needs and, like many other socially marginalised groups, often receive healthcare in inverse proportion to their needs. Improved continuity of healthcare over time could contribute to addressing these needs. General Practitioners need to be able to support people with complex social and medical problems, even in systems that are not specifically designed to manage individuals with such degrees of complexity. We aimed to examine offenders' perspectives on factors that contributed to, or worked against, creating and sustaining their access to healthcare.
From a sample of 200 participants serving community or prison sentences in South West (SW) and South East (SE) England, who were interviewed about their health care experiences as part of the Care for Offenders: Continuity of Access (COCOA) study, we purposively sampled 22 participants for this sub-study, based on service use. These interviews were transcribed verbatim. A thematic analytic approach initially applied 5 a priori codes based on access and different components of continuity. Data were then examined for factors that contributed to achieving and disrupting access and continuity.
Participants described how their own life situations and behaviours contributed to their problems in accessing healthcare and also identified barriers created by existing access arrangements. They also highlighted how some General Practitioners used their initiative and skills to 'workaround' the system, and build positive relationships with them; feeling listened to and building trust were particularly valued, as was clear communication. Limitations faced by General Practitioners included a lack of appropriate services to refer people to, where the offender patients would meet the access criteria, and disagreements regarding medication prescriptions.
General Practitioners can make a positive contribution to supporting access to healthcare for an under-served population by facilitating more flexible and less formal access arrangements, by using their relationship skills, and by problem-solving. General Practitioners should recognise their potential to transform people's experience of healthcare whilst working in imperfect systems, particularly with vulnerable and marginalised groups who have complex medical and social needs.
罪犯常常有大量的医疗需求，并且和许多其他社会边缘群体一样，他们获得医疗服务的情况往往与需求成反比。随着时间推移，改善医疗服务的连续性有助于满足这些需求。全科医生需要有能力为有复杂社会和医疗问题的人群提供支持，即便在并非专门设计用于管理如此复杂个体的系统中。我们旨在探究罪犯对于促成或阻碍其获得并维持医疗服务的因素的看法。
从在英格兰西南部（SW）和东南部（SE）服社区刑或监禁刑的200名参与者样本中，作为“罪犯关怀：就医连续性”（COCOA）研究的一部分，他们就其医疗经历接受了访谈，我们基于服务使用情况有目的地抽取了22名参与者进行这项子研究。这些访谈逐字记录。一种主题分析方法最初基于就医机会和连续性的不同组成部分应用了5个先验编码。然后检查数据中促成或破坏就医机会及连续性的因素。
参与者描述了他们自身的生活状况和行为如何导致他们在获得医疗服务方面存在问题，还指出了现有就医安排造成的障碍。他们还强调了一些全科医生如何发挥主动性和技能来“绕过”系统，并与他们建立积极的关系；被倾听和建立信任尤其受到重视，清晰的沟通也是如此。全科医生面临的限制包括缺乏合适的服务可供转介符合就医标准的罪犯患者，以及在药物处方方面存在分歧。
全科医生可以通过促成更灵活、更不正式的就医安排，运用他们的关系技能以及解决问题，为支持服务不足人群获得医疗服务做出积极贡献。全科医生应认识到，在不完善的系统中工作时，尤其是与有复杂医疗和社会需求的弱势群体和边缘群体合作时，他们有潜力改变人们的就医体验。
