老年囚犯健康和社会关怀评估及计划（OHSCAP）与常规治疗相比：一项随机对照试验。

The older prisoner health and social care assessment and plan (OHSCAP) versus treatment as usual: a randomised controlled trial.

机构信息

The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.

Lancashire Police, Saunders Lane, Hutton, PR4 5SB, UK.

出版信息

BMC Public Health. 2021 Nov 10;21(1):2061. doi: 10.1186/s12889-021-11965-5.

DOI:10.1186/s12889-021-11965-5

PMID:34758798

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8579542/

Abstract

BACKGROUND

Older people are the fastest-growing demographic group among prisoners in England and Wales and they have complex health and social care needs. Their care is frequently ad hoc and uncoordinated. No previous research has explored how to identify and appropriately address the needs of older adults in prison. We hypothesised that the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) would significantly increase the proportion of met health and social care needs 3 months after prison entry, compared to treatment as usual (TAU).

METHODS

The study was a parallel randomised controlled trial (RCT) recruiting male prisoners aged 50 and over from 10 prisons in northern England. Participants received the OHSCAP or TAU. A clinical trials unit used minimisation with a random element as the allocation procedure. Data analysis was conducted blind to allocation status. The intervention group had their needs assessed using the OHSCAP tool and care plans were devised; processes that lasted approximately 30 min in total per prisoner. TAU included the standard prison health assessment and care. The intention to treat principle was followed. The trial was registered with the UK Clinical Research Network Portfolio (ISRCTN ID: 11841493) and was closed on 30 November 2016.

RESULTS

Data were collected between 28 January 2014 and 06 April 2016. Two hundred and forty nine older prisoners were assigned TAU of which 32 transferred prison; 12 were released; 2 withdrew and 1 was deemed unsafe to interview. Two hundred and fifty three 3 prisoners were assigned the OHSCAP of which 33 transferred prison; 11 were released; 6 withdrew and 1 was deemed unsafe to interview. Consequently, data from 202 participants were analysed in each of the two groups. There were no significant differences in the number of unmet needs as measured by the Camberwell Assessment of Needs - Forensic Short Version (CANFOR-S). The mean number of unmet needs for the OHSCAP group at follow-up was 2.03 (SD = 2.07) and 2.06 (SD = 2.11) for the TAU group (mean difference = 0.088; 95% CI - 0.276 to 0.449, p = 0.621). No adverse events were reported.

CONCLUSION

The OHSCAP was fundamentally not implemented as planned, partly due to the national prison staffing crisis that ensued during the study period. Therefore, those receiving the OHSCAP did not experience improved outcomes compared to those who received TAU.

TRIAL REGISTRATION

Current Controlled Trials: ISRCTN11841493 , 25/10/2012.

摘要

背景

在英格兰和威尔士，老年人是囚犯中增长最快的群体，他们有复杂的医疗和社会护理需求。他们的护理通常是临时的和不协调的。以前没有研究探讨如何识别和适当满足监狱中老年人的需求。我们假设，与常规治疗（TAU）相比，老年囚犯健康和社会护理评估和计划（OHSCAP）将在入狱后 3 个月内显著增加满足健康和社会护理需求的比例。

方法

该研究是一项平行随机对照试验（RCT），从英格兰北部的 10 所监狱招募 50 岁及以上的男性囚犯。参与者接受 OHSCAP 或 TAU。临床试验单位使用最小化和随机元素作为分配程序。数据分析对分配状态进行了盲法处理。干预组使用 OHSCAP 工具评估他们的需求并制定护理计划；每个囚犯总共需要大约 30 分钟。TAU 包括标准的监狱健康评估和护理。遵循意向治疗原则。该试验已在英国临床研究网络组合（ISRCTN ID：11841493）中注册，并于 2016 年 11 月 30 日关闭。

结果

数据收集于 2014 年 1 月 28 日至 2016 年 4 月 6 日之间。249 名老年囚犯接受 TAU 治疗，其中 32 人转狱；12 人获释；2 人退出；1 人因不安全而无法接受采访。253 名囚犯被分配了 OHSCAP，其中 33 人转狱；11 人获释；6 人退出；1 人因不安全而无法接受采访。因此，两组各有 202 名参与者的数据进行了分析。使用坎伯韦尔需求评估-法医简短版（CANFOR-S）测量的未满足需求数量没有显著差异。OHSCAP 组在随访时未满足需求的平均数量为 2.03（SD=2.07），TAU 组为 2.06（SD=2.11）（平均差异=0.088；95%CI-0.276 至 0.449，p=0.621）。没有报告不良事件。