Spycher Jacques, Dusheiko Mark, Beaupère Pascale, Gravier Bruno, Moschetti Karine
Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
University of Lausanne, Lausanne, Switzerland.
Health Justice. 2021 May 13;9(1):11. doi: 10.1186/s40352-021-00136-8.
This study investigates the prisoner and prison-level factors associated with healthcare utilization (HCU) and the dynamic effects of previous HCU and health events. We analyze administrative data collected on annual adult prisoner-stay HCU (n = 10,136) including physical and mental chronic disease diagnoses, acute health events, penal circumstances and prison-level factors between 2013 and 2017 in 4 prisons of Canton of Vaud, Switzerland. Utilization of four types of health services: primary, nursing, mental and emergency care; are assessed using multivariate and multi-level negative binomial regressions with fixed/random effects and dynamic models conditional on prior HCU and lagged health events.
In a prison setting with health screening on detention, removal of financial barriers to care and a nurse-led gatekeeping system, we find that health status, socio-demographic characteristics, penal history, and the prison environment are associated with HCU overtime. After controlling for chronic and past acute illnesses, female prisoners have higher HCU, younger adults more emergencies, and prisoners from Africa, Eastern Europe, and the Americas lower HCU. New prisoners, pretrial detainees or repeat offenders utilize more all types of care. Overcrowding increases primary care but reduces utilization of mental and emergency services. Higher expenditure on medical staff resources is associated with more primary care visits and less emergency visits. The dynamics of HCU across types of care shows persistence over time related to emergency use, previous somatic acute illnesses, and acting out events. There is also evidence of substitution between psychiatric and primary care.
The prison healthcare system provides an opportunity to diagnose and treat unmet health needs for a marginalized population. Access to psychiatric and chronic disease management during incarceration and prevention of emergency or acute events can reduce future demand for care. Prioritization of high-risk patients and continuity of care inside and outside of prisons may reduce public health pressures in the criminal system. The prison environment and prisoners' penal circumstances impacts healthcare utilization, suggesting better coordination between the criminal justice and prison health systems is required.
本研究调查了与医疗保健利用（HCU）相关的囚犯及监狱层面因素，以及既往HCU和健康事件的动态影响。我们分析了2013年至2017年期间瑞士沃州4所监狱收集的成年囚犯年度住院HCU行政数据（n = 10136），包括身心慢性病诊断、急性健康事件、刑罚情况和监狱层面因素。使用具有固定/随机效应的多变量和多层次负二项回归以及基于先前HCU和滞后健康事件的动态模型，评估四种类型的医疗服务利用情况：初级、护理、精神和急诊护理。
在一个对拘留人员进行健康筛查、消除医疗保健经济障碍并采用护士主导的守门系统的监狱环境中，我们发现健康状况、社会人口特征、刑罚历史和监狱环境与长期的HCU相关。在控制了慢性和既往急性疾病后，女性囚犯的HCU更高，年轻人的急诊更多，来自非洲、东欧和美洲的囚犯的HCU更低。新囚犯、审前被拘留者或惯犯使用的各类护理更多。过度拥挤会增加初级护理，但会减少精神和急诊服务的利用。医疗人员资源支出较高与更多的初级护理就诊和更少的急诊就诊相关。不同类型护理的HCU动态显示，与急诊使用、既往躯体急性疾病和行为事件相关的时间持续性。也有证据表明精神护理和初级护理之间存在替代关系。
监狱医疗保健系统为诊断和治疗边缘化人群未满足的健康需求提供了机会。在监禁期间获得精神护理和慢性病管理以及预防急诊或急性事件可以减少未来的护理需求。对高危患者进行优先排序以及监狱内外护理的连续性可能会减轻刑事系统中的公共卫生压力。监狱环境和囚犯的刑罚情况会影响医疗保健利用，这表明刑事司法系统和监狱卫生系统之间需要更好地协调。
