Improving care quality with prison telemedicine: The effects of context and multiplicity on successful implementation and use

Abstract

Background Prison telemedicine can improve the access, cost and quality of healthcare for prisoners, however adoption in prison systems worldwide has been variable despite these demonstrable benefits. This study examines anticipated and realised benefits, barriers and enablers for prison telemedicine, thereby providing evidence to improve the chances of successful implementation. Methods A systematic search was conducted using a combination of medical subject headings and text word searches for prisons and telemedicine. Databases searched included: PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, Scopus and International Bibliography of the Social Sciences. Articles were included if they reported information regarding the use of/advocacy for telemedicine, for people residing within a secure correctional facility. A scoping summary and subsequent thematic qualitative analysis was undertaken on articles selected for inclusion in the review, to identify issues associated with successful implementation and use. Results One thousand, eight hundred and eighty-two non-duplicate articles were returned, 225 were identified for full text review. A total of 163 articles were included in the final literature set. Important considerations for prison telemedicine implementation include: differences between anticipated and realised benefits and barriers, differing wants and needs of prison and community healthcare providers, the importance of top-down and bottom-up support and consideration of logistical and clinical compatibility. Conclusions When implemented well, patients, prison and hospital staff are generally satisfied with telemedicine. Successful implementation requires careful consideration at outset of the partners to be engaged, the local context for implementation and the potential benefits that should be communicated to encourage participation.

Using telemedicine to improve access, cost and quality of secondary care for people in prison in England: a hybrid type 2 implementation effectiveness study

“…When using questionnaires, these must account for a population which is likely to have low literacy levels and an element of mistrust in research. In addition, as identified in our forthcoming literature review,12 prison and hospital healthcare providers are likely to anticipate and experience different and unequal benefits, barriers and facilitators which may affect enthusiasm for implementation.…”

“…The theory proposes four constructs: coherence, cognitive participation, collective action and reflexive monitoring 34 35. As identified in a systematic review of prison telemedicine,12 staff attitude and behaviour is reported to be both the main driver and barrier to successful implementation, making NPT particularly relevant to this intervention. Successful implementation elsewhere has found that staff at macro (board level), meso (departmental lead/managers) and micro levels (frontline delivery of telemedicine) must be engaged and enthused in the provision of the intervention, across a multiplicity of providers (community hospital, prison healthcare, wider prison staff) all who have differing needs, wants and beliefs 12…”

“…For example, dialling in to the telemedicine system will be the responsibility of the prison healthcare staff member and not the patient. Questions will also be informed by the literature review that precedes this protocol on enablers/barriers to prison telemedicine,12 for example, “where you able to access prison electronic health records contemporaneously?”.…”

“…Telemedicine refers to the use of technology, including video link, to allow remote consultation for patients without the need for direct physical contact with local health services. Telemedicine consultations have been used in prisons worldwide to reduce inequities in healthcare access experienced by prisoners,5–11 most notably in the USA and Australia 12. There is a large body of evidence which demonstrates their effectiveness at improving the access and cost of healthcare provision in prisons 13.…”

COVID-19: digital equivalence of health care in English prisons

“…Yet at the commencement of the pandemic, prisons were triply disadvantaged: first, in regard to the baseline poor health status of residents; second, by the closed and crowded prison environment; and third, by their poor adoption history of digital technologies. Widespread prison telemedicine implementation efforts previously struggled to find traction in England, 5 yet were suddenly perceived as one of the most important tools to maintain health-care service continuity throughout the pandemic ( appendix ). Despite the clear rationale for a rapid deployment programme to mirror community efforts, several issues emerged that inhibited the ability to transform health care in prison settings at the same speed.…”