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      Analysis of Emergency Healthcare Demand in a Prison Translated title: Análisis de la demanda sanitaria urgente en un centro penitenciario

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          Abstract

          Objective

          To analyze the reasons for seeking emergency medical care amongst prison inmates and their relationship to sociodemographic characteristics.

          Material and method

          An observational, descriptive and retrospective study was carried out. We collected the sociodemographic variables of inmates and their healthcare needs at the referral hospital over nine years.

          Results

          A total of 972 hospital visits were included. The most common healthcare needs, in descending order, were multiple trauma, limb problems and dyspnea. Mondays and Wednesdays were found to be the busiest days ( P <0.001). The average stay in cases of hospitalization was 6.1 (SD: 4.3) days; patients with nontraumatic healthcare needs required a longer stay. The majority of the inmates native to Africa, Asia and America received emergency healthcare services due to traumatic injuries; by contrast the most common injuries among Europeans were non-traumatic and unrelated to suicide attempts ( P <0.001). European inmates were on average 4.2 years older than Africans and 4.7 years older than American inmates ( P <0.001).

          Discussion

          The reasons for seeking emergency care are clearly differentiated according to the inmates’ nationality, one notable outcome was the greater longevity of European internees. These results highlight the importance of understanding healthcare demand within the prison system in order to better address considerations such as prevention, organization and the location of healthcare units.

          Resumen

          Objetivos

          Analizar los motivos de atención urgente hospitalaria de los internos de un centro penitenciario y su relación con sus características sociodemográficas.

          Material y método

          Estudio observacional, descriptivo y retrospectivo en el que se recogieron variables sociodemográficas y referentes a la demanda sanitaria urgente de los internos de un centro penitenciario durante nueve años.

          Resultados

          Se estudiaron un total de 972 atenciones hospitalarias. Los motivos de consulta más frecuentes fueron, en orden descendente: politraumatismos, problemas en las extremidades y disnea, siendo los lunes y miércoles los días de la semana con mayor afluencia (p <0,001). La estancia media en caso de hospitalización fue de 6,1 días (desviación estándar: 4,3), precisando más días de ingreso las causas no traumáticas ni los intentos de suicidio o las lesiones secundarias. La mayoría de los internos procedentes de África, Asia y América acudieron a los servicios de urgencias por lesiones traumáticas, al contrario que los europeos, que lo hicieron por lesiones no traumáticas y no relacionadas con tentativas de suicidio (p <0,001). Los internos europeos fueron 4,2 años mayores que los africanos y 4,7 años mayores que los americanos (p <0,001).

          Discusión

          Encontramos una clara diferencia entre los motivos de atención urgente en función de la nacionalidad de los internos, destacando que los europeos fueron los más longevos. Estos resultados manifiestan que el conocimiento de la demanda asistencial penitenciaria es de vital importancia en diversos aspectos, como organización, prevención y ubicación de unidades asistenciales.

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          Most cited references36

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          The health care utilization of people in prison and after prison release: A population-based cohort study in Ontario, Canada

          Background Many people experience imprisonment each year, and this population bears a disproportionate burden of morbidity and mortality. States have an obligation to provide equitable health care in prison and to attend to care on release. Our objective was to describe health care utilization in prison and post-release for persons released from provincial prison in Ontario, Canada in 2010, and to compare health care utilization with the general population. Methods We conducted a population-based retrospective cohort study. We included all persons released from provincial prison to the community in 2010, and age- and sex-matched general population controls. We linked identities for persons released from prison to administrative health data. We matched each person by age and sex with four general population controls. We examined ambulatory care and emergency department utilization and medical-surgical and psychiatric hospitalization, both in prison and in the three months after release to the community. We compared rates with those of the general population. Results The rates of all types of health care utilization were significantly higher in prison and on release for people released from prison (N = 48,861) compared to general population controls (N = 195,444). Comparing those released from prison to general population controls in prison and in the 3 months after release, respectively, utilization rates were 5.3 (95% CI 5.2, 5.4) and 2.4 (95% CI 2.4, 2.5) for ambulatory care, 3.5 (95% CI 3.3, 3.7) and 5.0 (95% CI 4.9, 5.3) for emergency department utilization, 2.3 (95% CI 2.0, 2.7) and 3.2 (95% CI 2.9, 3.5) for medical-surgical hospitalization, and 21.5 (95% CI 16.7, 27.7) and 17.5 (14.4, 21.2) for psychiatric hospitalization. Comparing the time in prison to the week after release, ambulatory care use decreased from 16.0 (95% CI 15.9,16.1) to 10.7 (95% CI 10.5, 10.9) visits/person-year, emergency department use increased from 0.7 (95% CI 0.6, 0.7) to 2.6 (95% CI 2.5, 2.7) visits/person-year, and hospitalization increased from 5.4 (95% CI 4.8, 5.9) to 12.3 (95% CI 10.1, 14.6) admissions/100 person-years for medical-surgical reasons and from 8.6 (95% CI 7.9, 9.3) to 17.3 (95% CI 14.6, 20.0) admissions/100 person-years for psychiatric reasons. Conclusions Across care types, health care utilization in prison and on release is elevated for people who experience imprisonment in Ontario, Canada. This may reflect high morbidity and suboptimal access to quality health care. Future research should identify reasons for increased use and interventions to improve care.
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            El triaje: herramienta fundamental en urgencias y emergencias

            El triaje es un proceso que permite una gestión del riesgo clínico para poder manejar adecuadamente y con seguridad los flujos de pacientes cuando la demanda y las necesidades clínicas superan a los recursos. Actualmente se utilizan sistemas de triaje estructurado con cinco niveles de prioridad que se asignan asumiendo el concepto de que lo urgente no siempre es grave y lo grave no es siempre urgente y hacen posible clasificar a los pacientes a partir del «grado de urgencia», de tal modo que los pacientes más urgentes serán asistidos primero y el resto serán reevaluados hasta ser vistos por el médico. El sistema español de triaje (SET) y el sistema de triaje Manchester (MTS) son los dos sistemas normalizados de mayor implantación en nuestro país, pero analizamos también el sistema de triaje elaborado en Navarra que se integra en la historia clínica informatizada (HCI) y que se utiliza en toda la red pública hospitalaria de Navarra. Todos son sistemas multidisciplinares basados en motivos y en la urgencia de la consulta pero no en diagnósticos y son llevados a cabo por enfermería con apoyo médico puntual. También todos incorporan elementos de monitorización de la calidad del propio servicio de urgencias y cuentan con proyección para poder ser aplicados en el ámbito extrahospitalario.
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              Low-intensity case management increases contact with primary care in recently released prisoners: a single-blinded, multisite, randomised controlled trial

              Background The world prison population is large and growing. Poor health outcomes after release from prison are common, but few programmes to improve health outcomes for ex-prisoners have been rigorously evaluated. The aim of this study was to evaluate the impact of individualised case management on contact with health services during the first 6 months post-release. Methods Single-blinded, randomised, controlled trial. Baseline assessment with N=1325 adult prisoners in Queensland, Australia, within 6 weeks of expected release; follow-up interviews 1, 3 and 6 months post-release. The intervention consisted of provision of a personalised booklet (‘Passport’) at the time of release, plus up to four brief telephone contacts in the first 4 weeks post-release. Results Of 1179 eligible participants, 1003 (85%) completed ≥1 follow-up interview. In intention-to-treat analyses, 53% of the intervention group and 41% of the control group reported contacting a general practitioner (GP) at 1 month post-release (difference=12%, 95% CI 5% to 19%). Similar effects were observed for GP contact at 3 months (difference=9%, 95% CI 2% to 16%) and 6 months (difference=8%, 95% CI 1% to 15%), and for mental health (MH) service contact at 6 months post release (difference=8%, 95% CI 3% to 14%). Conclusions Individualised case management in the month after release from prison increases usage of primary care and MH services in adult ex-prisoners for at least 6 months post-release. Given the poor health profile of ex-prisoners, there remains an urgent need to develop and rigorously evaluate interventions to increase health service contact in this profoundly marginalised population. Trial registration number ACTRN12608000232336.
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                Author and article information

                Journal
                Rev Esp Sanid Penit
                Rev Esp Sanid Penit
                sanipe
                Revista Española de Sanidad Penitenciaria
                Sociedad Española de Sanidad Penitenciaria
                1575-0620
                2013-6463
                Oct-Dec 2021
                19 December 2021
                : 23
                : 3
                : 91-97
                Affiliations
                [1 ] originalDepartamento de Medicina. Área de Enfermería. Universidad de Oviedo. Oviedo. España. normalizedUniversidad de Oviedo orgdiv1Departamento de Medicina orgdiv2Área de Enfermería orgnameUniversidad de Oviedo Oviedo, Spain
                [2 ] originalInstituto de Investigación Sanitaria del Principado de Asturias. Oviedo. España. orgnameInstituto de Investigación Sanitaria del Principado de Asturias Oviedo, España
                [3 ] originalHospital Universitario Central de Asturias. Oviedo. España. orgnameHospital Universitario Central de Asturias Oviedo, España
                Author notes
                Correspondence: Marta Sánchez-Zaballos Facultad de Medicina y Ciencias de la Salud. Departamento de Medicina. Área de Enfermería. Universidad de Oviedo. Av. Julián Clavería, s/n. 33006 Oviedo. Asturias. E-mail: sanchezzmarta@ 123456uniovi.es

                Conflicts of interest: The authors declare that they have no conflicts of interest with respect to this article.

                Article
                10.18176/resp.00037
                8802817
                9e150b0a-9583-4713-a3ec-50261c83e2ed

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 26 September 2020
                : 19 February 2021
                Page count
                Figures: 1, Tables: 1, Equations: 0, References: 34, Pages: 07
                Categories
                Original

                emergency medicine,emergencies,prisoners,public health,medicina de emergencia,urgencias médicas,prisiones,salud pública

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