responded by expediting the implementation of a law passed in North Carolina to enable individuals who are incarcerated to receive specialty care via telemedicine. 3 The purpose of this study was to evaluate the implementation of a telemedicine program for specialty care in North Carolina prisons during the COVID-19 pandemic. MethodsThis cross-sectional study was deemed exempt from review by the University of North Carolina at Chapel Hill institutional review board because the evaluation protocol met the definition of a limited data set under 45 CFR §164.514 (e). The North Carolina Department of Public Safety obtained written informed consent from all patients. A Data Use Agreement was executed between the North Carolina Department of Public Safety and the University of North Carolina at Chapel Hill. Since this research was limited to secondary data use with no contact with practitioners, the University of North Carolina at Chapel Hill institutional review board did not require research consent from practitioners or telepresenters. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.We conducted a cross-sectional study of the use of telemedicine to deliver secondary and tertiary health care by specialist physicians, nurse practitioners, (NPs), and physician assistants (PAs) to individuals who were incarcerated within 55 North Carolina prison facilities. We procured and implemented telemedicine software and equipment, developed a telemedicine workflow, and trained administrative and nursing staff as telepresenters to schedule and assist with telemedicine visits. Likewise, we designated practitioners in each participating specialty to provide care via telemedicine, reassigned established patients who were incarcerated to those practitioners, built practitioner schedules, developed a scheduling web portal and referral triage process, and trained practitioners to perform telemedicine visits and document these encounters in the prison electronic health record.Between June 1 and November 30, 2020, we distributed in-prison surveys for 1252 visits and collected 1584 surveys from patients (482 visits; response rate, 38.5%) and telemedicine presenters (739 visits; response rate, 59.0%). Patient race was self-identified and collected to assess whether there were racial disparities in telemedicine satisfaction. Additionally, we collected electronic surveys from practitioners at the end of each telemedicine shift, which covered 3232 visits performed by 60 Author affiliations and article information are listed at the end of this article.

More than 1.2 million adults are incarcerated in the United States and hence, require health care from prison systems. The current delivery of care to incarcerated individualss is expensive, logistically challenging, risk fragmenting care, and pose security risks. The purpose of this study was to evaluate the association of patient characteristics and experiences with the perceived telemedicine experiences of incarcerated individuals during the pandemic. We conducted a cross-sectional study of incarcerated individuals in 55 North Carolina prison facilities seeking medical specialty care via telemedicine. Data collection took place from June 1, 2020 to November 30, 2020. Of the 482 patient surveys completed, 424 (88%) were male, 257 (53.3%) were over 50 years of age, and 225 (46.7%) were Black or African American and 195 (40.5%) were White, and 289 (60%) no prior telemedicine experience. There were 3 strong predictors of how patients rated their telemedicine experience: personal comfort with telemedicine ( P-value < .001), wait time ( P-value < .001), and the clarity of the treatment explanation by the provider ( P-value < .001). There was a relationship between telemedicine experiences and how patient rated their experience. Also, patients who were less satisfied with using telemedicine indicated their preference for an in-clinic visit for their next appointment.

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