Abstract
Prison healthcare is an important public health concern given the increasing healthcare needs of a growing and aging prison population, which accumulates vulnerability factors and suffers from higher disease prevalence than the general population. This study identifies the key factors associated with outpatient general practitioner (GP), nursing or psychiatric healthcare utilization (HCU) within prisons. Cross-sectional data systematically collected by the prison medical staff were obtained for a sample of 1664 adult prisoners of the Canton of Vaud, Switzerland, for the year 2011. They contain detailed information on demographics (predisposing factors), diagnosed chronic somatic and psychiatric disorders (needs factors), as well as prison stay characteristics (contextual factors). For GP, nurse and psychiatric care, two-part regressions are used to model separately the probability and the volume of HCU. Predisposing factors are generally not associated with the probability to use healthcare services after controlling for needs factors. However, female inmates use higher volumes of care, and the volume of GP consultations increases with age. Chronic somatic and psychiatric conditions are the most important predictors of the probability of HCU, but associations with volumes differ in their magnitude and significance across disease groups. Infectious, musculoskeletal, nervous and circulatory diseases actively mobilize GP and nursing staff. Schizophrenia, illicit drug and pharmaceuticals abuse are strongly positively associated with psychiatric and nurse HCU. The occupancy rate displays positive associations among contextual factors. Prison healthcare systems face increasingly complex organizational, budgetary and ethical challenges. This study provides relevant insights into the HCU patterns of a marginalized and understudied population.
Highlights
Healthcare provision in prisons has recently been receiving much attention from public health stakeholders
This study identifies the epidemiological, demographic, and contextual factors associated with outpatient general practitioner (GP), nurse and psychiatric healthcare utilization (HCU) in prisons
Our results tend to show equity among prisoners, with predisposing factors and insurance generally not associated with HCU after controlling for needs factors. These findings suggest that part of the variation in HCU usually attributed to predisposing factors is explained by chronic conditions, and underline the importance of accounting for the confounding effect of chronic health conditions in studying HCU patterns
Summary
Healthcare provision in prisons has recently been receiving much attention from public health stakeholders. Prison health services are responsible for ensuring sufficient access and levels of quality of healthcare services to meet prisoners’ health needs. These needs are substantial and rising, as the prison population is growing worldwide [1,2], with a greater increase in the relative share of elderly inmates [3,4]. The characteristics of inmates and their environment partly explain why HCU is found to be greater in prison than in the general population [5,6,7,8]. Health and HCU in prisons may be affected by context-specific factors, such as anxiety, sedentariness, isolation, self-harm, confined environments or hope to obtain psychotropic medications, and organizational constraints, such as limited opportunities for health selfmanagment and lack of access to informal care [7,16,17,18]
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