Blackaby Jenna, Byrne Jordan, Bellass Sue, Canvin Krysia, Foy Robbie
Leeds Institute of Health Science, University of Leeds, Leeds, UK.
Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
Health Justice. 2023 Jan 3;11(1):1. doi: 10.1186/s40352-022-00200-x.
There are challenges to delivering high quality primary care within prison settings and well-recognised gaps between evidence and practice. There is a growing body of literature evaluating interventions to implement evidence-based practice in the general population, yet the extent and rigour of such evaluations in incarcerated populations are unknown. We therefore conducted a scoping literature review to identify and describe evaluations of implementation interventions in the prison setting.
We searched EMBASE, MEDLINE, CINAHL Plus, Scopus, and grey literature up to August 2021, supplemented by hand searching. Search terms included prisons, evidence-based practice, and implementation science with relevant synonyms. Two reviewers independently selected studies for inclusion. Data extraction included study populations, study design, outcomes, and author conclusions. We took a narrative approach to data synthesis. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for scoping reviews.
Fifteen studies reported in 17 papers comprised one randomised controlled trial, one controlled interrupted time series analysis and 13 uncontrolled before and after studies. Eight studies took place in the US and four in the UK. Ten studies evaluated combined (multifaceted) interventions, typically including education for staff or patients. Interventions most commonly targeted communicable diseases, mental health and screening uptake. Thirteen studies reported adherence to processes of care, mainly testing, prescribing and referrals. Fourteen studies concluded that interventions had positive impacts.
There is a paucity of high-quality evidence to inform strategies to implement evidence-based health care in prisons, and an over-reliance on weak evaluation designs which may over-estimate effectiveness. Whilst most evaluations have focused on recognised priorities for the incarcerated population, relatively little attention has been paid to long-term conditions core to primary care delivery. Initiatives to close the gaps between evidence and practice in prison primary care need a stronger evidence base.
在监狱环境中提供高质量的初级保健存在挑战，且证据与实践之间存在公认的差距。评估在普通人群中实施循证实践干预措施的文献越来越多，但在被监禁人群中此类评估的范围和严谨程度尚不清楚。因此，我们进行了一项范围综述，以识别和描述监狱环境中实施干预措施的评估情况。
我们检索了截至2021年8月的EMBASE、MEDLINE、CINAHL Plus、Scopus和灰色文献，并辅以手工检索。检索词包括监狱、循证实践和实施科学以及相关同义词。两名评审员独立选择纳入研究。数据提取包括研究人群、研究设计、结果和作者结论。我们采用叙述性方法进行数据综合。我们遵循系统评价和Meta分析的首选报告项目（PRISMA）指南进行范围综述。
17篇论文中报道的15项研究包括1项随机对照试验、1项对照中断时间序列分析和13项非对照前后研究。8项研究在美国进行，4项在英国进行。10项研究评估了综合（多方面）干预措施，通常包括对工作人员或患者的教育。干预措施最常见的目标是传染病、心理健康和筛查接受情况。13项研究报告了对护理过程的依从性，主要是检测、开处方和转诊。14项研究得出结论，干预措施有积极影响。
缺乏高质量证据为监狱中实施循证医疗保健的策略提供信息，且过度依赖可能高估有效性的薄弱评估设计。虽然大多数评估都集中在被监禁人群公认的优先事项上，但对初级保健提供核心的长期病症关注相对较少。缩小监狱初级保健中证据与实践之间差距的举措需要更坚实的证据基础。
