Collaborative Centre for Inclusion Health, University College London, London, UK
Institute of Health Informatics, University College London, London, UK.
BMJ Open. 2020 Feb 18;10(2):e035837. doi: 10.1136/bmjopen-2019-035837.
People in prison tend to experience poorer health, access to healthcare services and health outcomes than the general population. Use of video consultations (telemedicine) has been proven effective at improving the access, cost and quality of secondary care for prisoners in the USA and Australia. Implementation and use in English prison settings has been limited to date despite political drivers for change. We plan to research the implementation of a new prison-hospital telemedicine model in an English county to understand what factors drive or hinder implementation and whether the model can improve healthcare outcomes as demonstrated in other contextual settings.
We will undertake a hybrid type 2 implementation effectiveness study to gather evidence on both clinical and implementation outcomes. Data collection will be guided by the theoretical constructs of Normalisation Process Theory. We will prospectively collect data through: (1) prisoner/patient focus groups, interviews and questionnaires, (2) prison healthcare, hospital and wider prison staff interviews and questionnaires, (3) routine quality improvement and service evaluation data. Up to four prisons and three hospital settings in Surrey (England) will be included in the telemedicine research, dependent on their telemedicine readiness during the study period. Prisons proposed include male and female prisoners, remand (not yet sentenced) and sentenced individuals and different security categorisations. In addition, focus groups in five telemedicine naïve prisons will provide information on patient preconceptions and concerns surrounding telemedicine.
This study has received National Health Service Research Ethics Committee, Her Majesty's Prison and Probation Service National Research Committee and Health Research Authority approval. Dissemination of results will take place through peer-reviewed journals, conferences and existing health and justice networks.
与普通人群相比，监狱中的人往往健康状况较差，获得医疗保健服务的机会较少，健康状况也较差。视频咨询（远程医疗）已被证明可有效改善美国和澳大利亚囚犯的二级保健的可及性、成本和质量。尽管有变革的政治动力，但迄今为止，这种方法在英国监狱环境中的实施和使用仍受到限制。我们计划研究在英国一个县实施新的监狱-医院远程医疗模式，以了解哪些因素推动或阻碍了实施，并评估该模式是否可以改善医疗保健结果，就像在其他背景环境中所展示的那样。
我们将进行混合式 2 型实施有效性研究，以收集临床和实施结果方面的证据。数据收集将由正常化进程理论的理论结构指导。我们将通过以下方式进行前瞻性数据收集：（1）囚犯/患者焦点小组、访谈和问卷调查，（2）监狱保健、医院和更广泛的监狱工作人员访谈和问卷调查，（3）常规质量改进和服务评估数据。在萨里（英格兰）的多达四个监狱和三个医院环境中进行远程医疗研究，具体取决于研究期间的远程医疗准备情况。拟议的监狱包括男性和女性囚犯、还押（尚未判刑）和判刑人员以及不同的安全分类。此外，五个远程医疗新手监狱的焦点小组将提供有关患者对远程医疗的先入之见和担忧的信息。
这项研究已获得国民保健制度研究伦理委员会、英国监狱和缓刑服务国家研究委员会以及健康研究管理局的批准。结果将通过同行评议的期刊、会议和现有的卫生和司法网络进行传播。
