Long-term Condition Management for Prisoners: exploring prevalence and compliance with national monitoring processes

Nat Wright,Frances Hankins,Philippa Hearty

doi:10.32388/3y54bn

Abstract

BACKGROUND: Long-term conditions (LTCs) are a significant cause of morbidity and mortality and prisoner populations have a disproportionately high prevalence of risk factors for LTCs. The size and mean age of the prison population has increased rapidly in recent years. The UK Quality Outcomes Framework (QOF) is a national standardised framework embedded in community general practice with financial remuneration linked to assessment and ongoing review of key clinical outcomes pertaining to LTCs. However, healthcare in prisons in England is not linked to financial remuneration through the QOF framework and prison clinicians are not mandated to adhere to the framework. AIM: To explore prevalence of LTCs in remand prisons and measure compliance with QOF monitoring. DESIGN AND SETTING: Quantitative analysis of secondary data on SystmOne. METHODS: Secondary data analysis of data extracted from the prison primary care record pertaining to patient self-report of LTC, level of confirmation by supporting evidence and compliance with QOF monitoring frameworks. RESULTS: 17% of the sample had at least one LTC, the most common condition being asthma, confirmed in 12% of the sample. Having an LTC was associated with female gender and increasing age. Prevalence rates for the other LTCs were hypertension 3%, epilepsy was 3%, coronary heart disease 2%, diabetes 2% and chronic obstructive pulmonary disease 1%. Just 34% of the eligible sample had had a QOF template completed. Higher rates of completion were associated with younger age and there were also statistically significant inter-prison differences. CONCLUSION: There is a pressing need to embed standardised QOF monitoring systems within an integrated community/prison commissioning framework supported by connectivity between prison and community primary care records of not just the summary care record but also all activity related to QOF compliance.

Highlights

By extracting routinely collected clinical data, we explored the prevalence of Long-term conditions (LTCs), compliance with both first and second assessment, and Quality Outcomes Framework (QOF) monitoring processes
Summary Our findings highlight the significant challenges of managing LTCs in remand prison settings, as highlighted by the fact that 75% of prisoners were no longer in the receiving study prison six months after entering the prison
Still being in the receiving study prison at six months was not associated with an increased likelihood of having either a co-morbid mental health or physical LTC

Summary

Introduction

Medical indemnity organisations acknowledge that patients in prison may be examined and treated in situations that are far from the norm for the rest of society They provide examples of consultations which may take place without access to GP or hospital records or may be held in an environment that could compromise safety for both patient and doctor. [[8]] This is commonplace when patients enter remand prisons outside of normal working hours and are assessed in first night prison reception centres In such an environment there are significant threats to effective medicines management - defined as “a system of processes and behaviours that determines how medicines are used by patients and by the NHS”. Long-term conditions (LTCs) are a significant cause of morbidity and mortality and prisoner populations have a disproportionately high prevalence of risk factors for LTCs. The size and mean age of the prison population has increased rapidly in recent years. Conclusion: There is a pressing need to embed standardised QOF monitoring systems within an integrated community/prison commissioning framework supported by connectivity between prison and community primary care records of not just the summary care record and all activity related to QOF compliance

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