Inmates In Correctional Facilities Research Articles

Evaluation of cost-effectiveness of peginterferon plus ribavirin for chronic hepatitis C treatment and direct-acting antiviral agents among HIV-infected patients in the prison and community settings.

In Taiwan, the majority of chronic hepatitis C carriers with HIV co-infection are intravenous drug users and inmates in correctional facilities. Peginterferon and ribavirin (PegIFN/RBV) have been the standard-of-care for chronic hepatitis C virus (HCV) infection more than decades. We evaluated the estimated cost-effectiveness of PegIFN/RBV from the National Health Insurance Research Database, covering the population of Taiwan from 1998 to 2013. This is an observational study, and study during was 2010-2016 and a total of 239 patients were treated with PegIFN/RBV. Of them, 156 patients were treated in the correctional facilities of Taipei, Taoyuan, Taichung and Taitung prisons, and 83 patients were treated in communities. The cost-effectiveness was analyzed in regimens of PegIFN/RBV and direct-acting antiviral agents. By multivariate analysis, the patients completed PegIFN/RBV in prison (adjusted odds ratio [aOR]: 4.56, 95% confidence interval [CI]: 1.58-13.12, p=0.005), HCV RNA level <800,000IU/mL (aOR: 4.0, 95% CI: 1.27-12.66, p=0.02) at baseline, and the presence of early virologic response (EVR) (aOR: 7.67, 95% CI: 1.89-31.06, p=0.004) were independent predictors for sustained virologic response (SVR). For the subgroups of prisoners, HIV-infected prisoners and HIV-infected patients in communities, the SVR rate was 73.8%, 72.0% and 36.8%, and the average medical-care cost was US$7,701, $7,893, and $15,443 per SVR achieved, respectively. Also, the estimated medical-care cost for genotype 6 was US$9211. Chronic HCV/HIV co-infected patients with genotype 1 and 6 in the community setting could benefit from DAAs in Taiwan.

The selective correctional healthcare system and stigma

본 연구는 교정의료처우에 대한 보건학 중심의 접근이 환자로서 치료받을 권리를 적극 주장하기 어려운 교정시설 수용자들의 상황을 구체화하지 못하였다는 문제의식에서 출발한다. 이에 본 연구는 교정시설에 수용되어 있는 기간 중 의료 처우를 경험한 수용자 8명의 구술을 Goffman(1963)의 스티그마 논의를 연결지어선별적으로 작동하고 있는 교정의료처우 체계와 크게 낙인, 고정관념, 구분, 지위상실, 차별의 다섯 가지 유형으로 나타나는 수용자들의 스티그마 경험을 드러내 고자 했다. ‘환자’와 ‘수용자’에 대한 고정관념에 기반하여 의료과 직원은 ‘치료할 가치 있는 수용자’를 구분하게 되는데, 이는 감시하는 ‘우리’와 감시하는 ‘그들’간의 위계적 역학관계 및 구별짓기와도 깊이 연결되어 있다. ‘치료할 가치 있는 수용자’에 대한 감독자들의 고정관념은 수용자들에게 전이되어 수용자들 간에도 한정된 의료자원 배분을 둘러싸고 아픔의 경중을 구분하는 ‘걸러내기’가 이루어지고 있다. 수용자들에게 외부진료로 발생한 비용을 전액 또는 일부 부담토록 하는 현 교정의료처우 체계는 이러한 걸러내기를 정당화하고 합리화하며, 그 결과 수용자들에게 교정시설 내 의료과는 아픔과 고통을 치유하는 공간이라기보다는 원하는 진 료를 받기 위해 거쳐야 하는 ‘창구’로 인식되고 있다. 교정의료처우 체계가 사회적 자원이 제한된 구금 환경의 수용자에게 건강을 회복하고 존엄성을 유지하는 마지막 수단으로 재인식되기 위해서는 교정의료처우와 관련하여 스티그마를 경 험한 수용자들의 목소리에 귀 기울이고 이를 공유하는 작업의 지속과 확산이 전제되어야 할 것이다.The study starts with the critical review on the perspectives of public health regarding healthcare in correctional settings that fail to describe situations of inmates in correctional facilities who have difficulty in claiming actively their rights to healthcare. In respond to the criticism, the study links Goffman (1963)’s discourse on stigma to the verbal presentations of 8 inmates for interpreting a selective character of correctional healthcare system and their stigma experiences that can be largely defined by 5 components &#8212;labeling, stereotyping, separation, status loss, and discrimination. Based on the stereotype on ‘patient’ and ‘inmate’, the personnel of healthcare department in the facilities sort ‘inmates worthy of care’ out, which is deeply related to the hierarchical dynamics and the distinction between us/the watcher and them/the watched. The stereotype of the personnel on ‘inmates worthy of care’ shifts to the inmates, resulting in ‘filtering’ among inmates to win limited medical resources in the facilities and weigh the relative seriousness of an illness. The current healthcare system in correctional facilities that makes inmates to bear all/some expenses of outpatient healthcare justifies and rationalizes this filtering. The healthcare department in the facilities, as a result, is regarded to the inmates as a ‘counter’ to pass over for a desired healthcare service, rather than a place for healing illness and pain. A continuance and proliferation of the research that focuses on the ‘voice’ of stigmatized inmates is a prerequisite to reappraise the correctional healthcare system as a last resort that maintain health and dignity for incarcerated inmates.

Coping with stress and the sense of quality of life in inmates of correctional facilities.

The aim of the study was to examine the differences between groups of prison inmates distinguished according to the sense of quality of life in terms of their ways of coping with stress. In order to verify the research hypotheses, the following instruments were used: (1) The sense of quality of life Questionnaire (SQLQ) by M. Straś-Romanowska (2007) and (2) the COPE Inventory by Carver, Scheier and Weintraub (1989). The results of the presented research have confirmed that the ways of coping with stress used by prison inmates are related to the sense of quality of life. This conclusion applies not only to overall sense of quality of life but also to all of its dimensions: psychophysical, psychosocial, personal, and metaphysical one. According to the assumed hypothesis, people with a high level of overall quality of life significantly more often than people with a low level of quality of life prefer active coping strategies, including strategies such as: Active coping, Planning, Searching for instrumental support, Searching for emotional support, Positive revaluation and development. Asimilar conclusion with minor modifications also applies to other dimensions of quality of life. Thus, the use of constructive ways of coping with stress - based on seeking support, personal activity in coping with problems and drawing conclusions from wrong life decisions - is related to higher level of quality of life.

A systematic review of transmission dynamic studies of methicillin-resistant Staphylococcus aureus in non-hospital residential facilities

BackgroundNon-hospital residential facilities are important reservoirs for MRSA transmission. However, conclusions and public health implications drawn from the many mathematical models depicting nosocomial MRSA transmission may not be applicable to these settings. Therefore, we reviewed the MRSA transmission dynamics studies in defined non-hospital residential facilities to: (1) provide an overview of basic epidemiology which has been addressed; (2) identify future research direction; and (3) improve future model implementation.MethodsA review was conducted by searching related keywords in PUBMED without time restriction as well as internet searches via Google search engine. We included only articles describing the epidemiological transmission pathways of MRSA/community-associated MRSA within and between defined non-hospital residential settings.ResultsAmong the 10 included articles, nursing homes (NHs) and correctional facilities (CFs) were two settings considered most frequently. Importation of colonized residents was a plausible reason for MRSA outbreaks in NHs, where MRSA was endemic without strict infection control interventions. The importance of NHs over hospitals in increasing nosocomial MRSA prevalence was highlighted. Suggested interventions in NHs included: appropriate staffing level, screening and decolonizing, and hand hygiene. On the other hand, the small population amongst inmates in CFs has no effect on MRSA community transmission. Included models ranged from system-level compartmental models to agent-based models. There was no consensus over the course of disease progression in these models, which were mainly featured with NH residents /CF inmates/ hospital patients as transmission pathways. Some parameters used by these models were outdated or unfit.ConclusionsImportance of NHs has been highlighted from these current studies addressing scattered aspects of MRSA epidemiology. However, the wide variety of non-hospital residential settings suggest that more work is needed before robust conclusions can be drawn. Learning from existing work for hospitals, we identified critical future research direction in this area from infection control, ecological and economic perspectives. From current model deficiencies, we suggest more transmission pathways be specified to depict MRSA transmission, and further empirical studies be stressed to support evidence-based mathematical models of MRSA in non-hospital facilities. Future models should be ready to cope with the aging population structure.

Economic modelling of telehealth substitution of face-to-face specialist outpatient consultations for Queensland correctional facilities.

Objective The provision of healthcare services to inmates in correctional facilities is costly and resource-intensive. This study aimed to estimate the costs of transporting prisoners from 11 Queensland correctional facilities to the Princess Alexandra Hospital Secure Unit (PAHSU) in Brisbane for non-urgent specialist outpatient consultations and identify the cost consequences that would result from the substitution of face-to-face visits with telehealth consultations. Methods A 12-month retrospective review of patient activity at the PAHSU was conducted to obtain the number of transfers per correctional facility. The total cost of transfers was calculated with estimates for transport vehicle costs and correctional staff escort wages, per diem and accommodation costs. A cost model was developed to estimate the potential cost savings from substituting face-to-face consultations with telehealth consultations. A sensitivity analysis on the cost variables was conducted. Costs are reported from a government funding perspective and presented in 2016 Australian dollars (A$). Results There were 3539 inmate appointments from July 2015 to June 2016 at the PAHSU, primarily for imaging, general practice, and orthopaedics. Telehealth may result in cost savings from negligible to A$969731, depending on the proportion, and travel distance, of face-to-face consultations substituted by telehealth. Wages of correctional staff were found to be the most sensitive variable. Conclusions Under the modelled conditions, telehealth may reduce the cost of providing specialist outpatient consultations to prisoners in Queensland correctional facilities. Telehealth may improve the timeliness of services to a traditionally underserved population. What is known about the topic? Specialist medical services are located in only a few metropolitan centres across Australia, which requires some populations to travel long distances to attend appointments. Some face-to-face specialist outpatient consultations can be substituted by telehealth. What does this paper add? Prisoners from correctional facilities represent one specific population that requires complex travel arrangements for specialist medical appointments. Transportation of prisoners for specialist health appointments represents a substantial cost to the government. This paper quantifies the annual cost in Queensland for transporting prisoners, taking into account fuel and vehicle costs, staff wages, per diem rates, and accommodation. In addition, it quantifies the costs of substituting face-to-face consultations with telehealth consultations. What are the implications for practitioners? This research encourages practitioners to consider using telehealth services for prisoners, as well providing an argument for tertiary centres to include telehealth as a model of care for this population. Telehealth can result in major cost savings and state and federal governments should consider implementation especially in Australia where correctional facilities and specialist services are separated by great geographic distances.

Relation of attitudes toward environment and animals with social and criminal-aggressive profile of adult inmates in school classes of a correctional facilitys

Aim of this research is to detect determinants and effects of environmental and animal-related attitudes of inmates. A sample of correctional facility inmates in the prison secondary school was collected in 2015 (class A=23 inmates, average 36 years, and B=12 inmates, average 33 years old, all male). Standardized questionnaires were answered and analytic statistics (Spearman test) was used. Preference for socialization or loneliness in nature or urban environment, aggression to animals, vegetarianism and susceptibility to environmental practices are correlated with the inmates criminal and behavioral profile as well as with their advancement in the education program of the prison school. Their education in prison seems to have positive environmental education effects. Positive attitudes of inmates toward animals is related with their family background, susceptibility of loneliness in nature, no hunting, involvement in environmental or cultural organization, susceptibility to impulsively impose protective values and norms, minimal aggressiveness, no crimes committed under angry circumstances or cyber-crimes, socializing in prison. Thereby, there is a noticeable accordance of vegetarianism, nature- and animal- attitudes of the inmates.

Special Needs Under Siege: From Classrooms to Incarceration

AbstractSeveral research articles have documented the disproportionate representation of minorities in school discipline and incarceration settings. In the 2009–2010 school year, research shows nationally 17 percent of African‐American, 8 percent of Native American, and 7 percent Latino American students were suspended at least one time (Losen and Gillespie ). In addition, studies show African‐American and Latino males represent the largest percentage of inmates in correctional facilities (i.e. jails and prisons) throughout the United States (Sakala ). While research has documented the relationship between race and the school‐to‐prison pipeline, the relationship between race, intellectual and emotional disabilities, and the school‐to‐prison pipeline has been relatively unexplored. According to Losen and Gillespie (), 25 percent of Black students who were labeled with an intellectual or emotional disability were suspended from school in the 2009–2010 school year compared to 9 percent for White students diagnosed with an intellectual or emotional disability. Furthermore, data show 70 percent of juvenile inmates were diagnosed with learning disabilities and 33 percent were reading below a 4th grade level (Hubner and Wolfson ). The current review seeks to explore the complex relationship between disability, race, and the school‐to‐prison pipeline to highlight how minority students with special needs are placed on a trajectory towards settings of incarceration.

Expert Opinion and Recommendations for the Management of Attention-Deficit/Hyperactivity Disorder in Correctional Facilities.

There has been considerably less research on the management of adult attention-deficit/hyperactivity disorder (ADHD) among the inmates of correctional facilities than in the general community. While the successful identification and management of ADHD in the adult correctional setting offer potential benefits to the individuals themselves, to institutional staff, and to wider society, their implementation represents significant challenges. These include high prevalence rates, the low level of ADHD recognition, the high incidence of comorbid psychiatric disorders, and the high risk of abuse and diversion of prescribed medications. Here, the authors provide an overview of current recommendations for the identification and management of adults with ADHD in correctional settings and discuss possible strategies for their further development.

Evaluation of an existing parenting class within a women's state correctional facility and a parenting class modeled from Parent–Child Interaction Therapy

Approximately 336,000 households with minor children are believed to be directly affected by parental imprisonment, and the majority of inmates in correctional facilities across the United States have been reported to be parents of minors (Mumola, 2000). Subsequently, parent training provided through correctional programming has the potential to impact a large number of American children affected by parental incarceration. However, there are no empirically supported “best practices” for parenting programs provided during incarceration and programs often vary across facilities. The current study examines an existing parenting class offered within a correctional facility and a parenting class modeled from Parent–Child Interaction Therapy (PCIT), a program with an existing evidence base for improving parent and child outcomes. Eighty-two women incarcerated in a female, state correctional facility were randomized to one of the two parenting models. Both parenting models were matched in dose to the facility's existing program, of weekly, 90-minute, group parenting classes, consisting of 10–15 mothers. Seventy-one women completed the parenting classes. Participants in both models were combined for pre-treatment and post-treatment assessments that included group administration of self-report measures and individual behavior observations of parenting interaction role-plays. At post-treatment, mothers completing the PCIT-based training demonstrated higher levels of parenting skills and reported higher levels of treatment satisfaction than mothers completing the existing facility class. Mothers completing the existing class reported higher levels of parenting knowledge of child development than the PCIT-based class. Following both parenting models, similar decreases were found between groups in parenting stress and child abuse potential.

Measuring the Prevalence of Current, Severe Symptoms of Mental Health Problems in a Canadian Correctional Population

This study measured the prevalence of current, severe symptoms of a mental health problem in an adult population of inmates in Ontario, Canada. The Resident Assessment Instrument-Mental Health was used to measure the prevalence of symptoms among a sample of 522 inmates. Propensity score weighting was used to adjust for nonrandom selection into the sample. Prevalence estimates were derived for the total inmate population, remand and sentenced, males and females, and Aboriginal and non-Aboriginal inmates. It is estimated that 41.1% of Ontario inmates will have at least one current, severe symptom of a mental health problem; of this group, 13.0%, will evidence two or more symptoms. The number of symptoms is strongly associated with presence of a psychiatric diagnosis and level of mental health care needs. Female (35.1%) and Aboriginal (18.7%) inmates are more likely to demonstrate two or more current, severe symptoms. Greater efforts must be made to bridge the gap between correctional and mental health care systems to ensure inmates in correctional facilities can access and receive appropriate mental health care services.

Telepsychiatry in Correctional Facilities: Using Technology to Improve Access and Decrease Costs of Mental Health Care in Underserved Populations

It is unclear if telepsychiatry, a subset of telemedicine, increases access to mental health care for inmates in correctional facilities or decreases costs for clinicians or facility administrators. The purpose of this investigation was to determine how utilization of telepsychiatry affected access to care and costs of providing mental health care in correctional facilities. A literature review complemented by a semistructured interview with a telepsychiatry practitioner. Five electronic databases, the National Bureau of Justice, and the American Psychiatric Association Web sites were searched for this research, and 49 sources were referenced. The literature review examined implementation of telepsychiatry in correctional facilities in Arizona, California, Georgia, Kansas, Ohio, Texas, and West Virginia to determine the effect of telepsychiatry on inmate access to mental health services and the costs of providing mental health care in correctional facilities. Telepsychiatry provided improved access to mental health services for inmates, and this increase in access is through the continuum of mental health care, which has been instrumental in increasing quality of care for inmates. Use of telepsychiatry saved correctional facilities from $12,000 to more than $1 million. The semistructured interview with the telepsychiatry practitioner supported utilization of telepsychiatry to increase access and lower costs of providing mental health care in correctional facilities. Increasing access to mental health care for this underserved group through telepsychiatry may improve living conditions and safety inside correctional facilities. Providers, facilities, and state and federal governments can expect increased savings with utilization of telepsychiatry.

Psychotropic medication abuse by inmates in correctional facilities

I noted an alarming surge in the prescribing of quetiapine (Seroquel) in our County correctional facility, Santa Rita Jail, approximately five years ago. The number of quetiapine tablets dispensed surpassed all other antipsychotic medications combined, in the observed three-month period. This sudden four-fold increase in prescribing to inmates by our psychiatrists was extremely unusual and warranted further investigation.

Integrated Trauma Treatment in Correctional Health Care and Community-Based Treatment Upon Reentry

Given the crisis of mass incarceration in the United States and the high prevalence of trauma histories among those incarcerated, it is imperative to improve service delivery to inmates in correctional facilities and to those undergoing reentry in community-based treatment settings. This article provides trauma definitions and categories, describes the sequelae of trauma, reviews research on the high prevalence of incarceration in this nation, and reviews research on the high prevalence of trauma among the incarcerated. This article also provides a menu of evidence-based and promising treatment approaches to address the overlap among trauma, mental illness, substance abuse, and behavioral problems. A synthesis of research via seven points is meant to guide practitioner and policy responses to the national challenge of meeting the needs of those undergoing reentry.

Assessing Criminal History as a Predictor of Future Housing Success for Homeless Adults With Behavioral Health Disorders

Homeless adults with serious mental illnesses and chronic substance abuse problems have few housing options, a problem compounded when a criminal background is present. This study compared the criminal backgrounds and other characteristics of homeless individuals who succeeded in housing (retained housing continuously for two years) and those who failed in housing. The study population consisted of homeless adults with behavioral health disorders who moved into supportive housing between January 1, 2000, and June 30, 2004, regardless of criminal background. Data about criminal history and other characteristics were extracted from existing records and analyzed for associations with housing success. Chi square tests and logistic regression analysis were used to find characteristics predictive of subsequent housing success or failure. Data were available for 347 participants. Most (51%) had a criminal record, and 72% achieved housing success. The presence of a criminal background did not predict housing failure. Younger age at move-in, the presence of a substance abuse problem, and higher numbers of drug crimes and property crimes were separately associated with more housing failure; however, when they were adjusted for each of the other variables, only move-in age remained associated with the outcome. The finding that criminal history does not provide good predictive information about the potential for housing success is important because it contradicts the expectations of housing operators and policy makers. The findings suggest that policies and practices that keep homeless people with criminal records out of housing may be unnecessarily restrictive.

Reported HIV Status of Tuberculosis Patients—United States, 1993-2005

Knowing the human immunodeficiency virus (HIV) status of tuberculosis (TB) patients is essential to optimal patient management. TB is an acquired immunodeficiency syndrome (AIDS)-defining opportunistic condition. Patients with both TB and HIV infection are five times more likely to die during anti-TB treatment than patients who are not HIV infected (CDC, unpublished data, 2003). HIV infection is the greatest known risk factor for progression from latent TB infection to TB disease. In the United States, after TB exposure and infection, HIV-infected persons who do not receive appropriate treatment progress to TB disease over 5 years at a rate 10 times greater than that for persons not infected with HIV. In 1989, CDC recommended that all TB patients be offered HIV testing and, in 2006, called for routine HIV screening of all TB patients after the patient is notified that testing will be performed, unless the patient declines (opt-out screening). In addition to enabling optimal patient management, knowing the HIV status (i.e., positive or negative) of TB patients helps public health agencies to identify HIV-infected contacts of TB patients. Highly active antiretroviral therapy (HAART) can reduce the progression to TB disease, TB relapse, and death. To assess reported HIV status of TB patients and selected characteristics of TB patients with HIV infection, CDC analyzed data from the U.S. National TB Surveillance System for the period 1993-2005. This report summarizes the results of that analysis, which indicated that 1) reporting of HIV status among TB patients increased from 35% in 1993 to 68% in 2003, 2) HIV status of 31% of TB patients was unknown in 2005, 3) 9% of TB patients were HIV positive in 2005, and 4) groups of TB patients at greater risk for HIV infection included injection-drug users (IDUs), noninjection-drug users (NIDUs), homeless persons, non-Hispanic blacks, correctional-facility inmates, and alcohol abusers. Increased promotion of routine HIV testing and rapid HIV tests might increase acceptability of testing, which would allow health-care providers to know the HIV status of a greater percentage of TB patients and enable them to provide optimal care.

Successful Reentry: The Perspective of Private Correctional Health Care Providers

Due to public health and safety concerns, discharge planning is increasingly prioritized by correctional systems when preparing prisoners for their reintegration into the community. Annually, private correctional health care vendors provide $3 billion of health care services to inmates in correctional facilities throughout the U.S., but rarely are contracted to provide transitional health care. A discussion with 12 people representing five private nationwide correctional health care providers highlighted the barriers they face when implementing transitional health care and what templates of services health care companies could provide to state and counties to enhance the reentry process.

Revamping a Master Gardener Curriculum for Use in Prison Job Readiness Programs

University of Nevada Cooperative Extension (UNCE) faculty members have taught horticulture to inmates of correctional facilities for over 8 years. The training material used was the Master Gardener curriculum. Because inmates in Nevada have few opportunities to meet requirements for certification as Master Gardeners, this program was described simply as a horticulture class. Over the past 3 years, we have redirected it toward job readiness to assist inmates after release. The curriculum was first expanded to do intensive teaching on such topics as irrigation, landscape plant selection and maintenance, and problem solving. Even with these changes, horticulture jobs generally limited to low-paying, entry level ones. To improve employment opportunities, UNCE obtained the involvement of the Nevada Department of Agriculture. After inmates have passed the horticulture program, they may take the state pesticide applicator training and examination. This year, a mini course in “Developing a Business Model” will be added to the initial curriculum. To date, 36 inmates have received PAT certification. Conversations with potential employers indicate that this significantly enhances their likelihood of employment at a higher-than-entry level.

Two community hepatitis B outbreaks: An argument for vaccinating incarcerated persons

Current recommendations have not resulted in routine vaccination of correctional facility inmates for hepatitis B. We investigated two hepatitis B outbreaks. Outbreak 1 involved 4 cases epidemiologically linked to persons who had been in jail. Outbreak 2 involved 48 community cases; 69% had a history of incarceration. Two-thirds of the cases in these outbreaks might have been prevented by a program of routine vaccination of local jail inmates. Priority should be given to developing and supporting practical programs to vaccinate the high-risk populations in correctional facilities against hepatitis B.

Delivery of cancer care to inmates of correctional facilities through telemedicine

8142 Background: Provision of hematology/oncology and palliative care to inmates in correctional facilities is challenging for oncologists, facility healthcare providers and patients. Necessary consultation may not be readily available to the inmate population due to multiple barriers, including distance, expense, safety and inability of inmates to travel due to illness. Methods: Using real-time videoconferencing, with clear audio and video connections, we are making symptom management, surveillance and chemotherapy follow-up visits by telemedicine, reducing the expense of security personnel and travel to tertiary care centers from correctional facilities. Most importantly, we are able to minimize discomfort for the inmate with cancer, who must endure long distance travel, wear shackles for prolonged periods and undergo possible embarrassment of being seen in public in shackles and prison garb. So far, we have seen patients with acute leukemia, lung cancer and deep venous thrombosis secondary to a hypercoagulable state. Results: We are able to examine the patient, evaluate symptoms, answer questions, and discuss management with the facility providers. Our interventions have resulted in closer and more frequent evaluation than if the patient were being seen in the clinic. The patients are appreciative of the telemedicine visits, and it appears that their needs and concerns receive more consideration because of heightened visibility. Facility providers are also appreciative of the chance to discuss the patients' case and ask questions of specialists in real time. Communication and staff education, especially in issues of palliative care are enhanced, as well as education of oncology fellows in this special form of care delivery. Laboratory and radiographic studies may be done locally and reviewed at the time of the visit. Conclusions: Telemedicine provides safe, timely, cost-conscious, and comfortable evaluation and management when the patient does not need to be seen in person or receive therapy in the clinic. We next plan to survey inmates, guards and providers, as well as evaluate cost in personnel and travel time to quantify our findings. No significant financial relationships to disclose.

Delivery of cancer care to inmates of correctional facilities through telemedicine

8142 Background: Provision of hematology/oncology and palliative care to inmates in correctional facilities is challenging for oncologists, facility healthcare providers and patients. Necessary consultation may not be readily available to the inmate population due to multiple barriers, including distance, expense, safety and inability of inmates to travel due to illness. Methods: Using real-time videoconferencing, with clear audio and video connections, we are making symptom management, surveillance and chemotherapy follow-up visits by telemedicine, reducing the expense of security personnel and travel to tertiary care centers from correctional facilities. Most importantly, we are able to minimize discomfort for the inmate with cancer, who must endure long distance travel, wear shackles for prolonged periods and undergo possible embarrassment of being seen in public in shackles and prison garb. So far, we have seen patients with acute leukemia, lung cancer and deep venous thrombosis secondary to a hypercoagulable state. Results: We are able to examine the patient, evaluate symptoms, answer questions, and discuss management with the facility providers. Our interventions have resulted in closer and more frequent evaluation than if the patient were being seen in the clinic. The patients are appreciative of the telemedicine visits, and it appears that their needs and concerns receive more consideration because of heightened visibility. Facility providers are also appreciative of the chance to discuss the patients' case and ask questions of specialists in real time. Communication and staff education, especially in issues of palliative care are enhanced, as well as education of oncology fellows in this special form of care delivery. Laboratory and radiographic studies may be done locally and reviewed at the time of the visit. Conclusions: Telemedicine provides safe, timely, cost-conscious, and comfortable evaluation and management when the patient does not need to be seen in person or receive therapy in the clinic. We next plan to survey inmates, guards and providers, as well as evaluate cost in personnel and travel time to quantify our findings. No significant financial relationships to disclose.