JMIR Publications

ABSTRACT

Background:

In comparison to the general population, prison inmates are at a higher risk for drug abuse, psychiatric as well as infectious diseases. Although intramural health care has to be equivalent to extramural services, prison inmates have less access to primary and secondary care. Furthermore, not every prison is constantly staffed with a physician. Since transportation to the nearest extramural medical facility is often resource-intensive, video consultations may offer cost-effective health care for prison inmates.

Objective:

To quantify the need for referrals to secondary care services and hospital admissions when video consultations with family physicians and psychiatrists are offered in prison.

Methods:

In five German prisons, a mixed-methods evaluation study was conducted in order to assess feasibility, acceptance and reasons for conducting video consultations with family physicians and psychiatrists. This analysis uses , quantitative data from these consultations (June 2018 to February 2019) in addition to data from a 6th prison added in January 2019 focusing on referral and admission rates, as well as reasons for encounters.

Results:

At the initiation of the project, 2499 prisoners were detained in the 6 prisons. A total of 435 video consultations were conducted by 12 physicians (3 female and 7 male family physicians, 2 male psychiatrists during the study period. The majority were scheduled consultations (n=341 / 78%). In 68% (n=294) of all encounters the patient was asked to consult a physician again if symptoms persisted or got worse. In 26% (n=115) a follow-up appointment with either the video consultant or prison physician was scheduled. A referral to other specialties, most often psychiatry, was necessary in 4% (n=17) of the cases. Only in 2% (n=8) of the consultations a hospital admission was needed. Usually hospital admissions were the result of unscheduled consultations and the video conferencing system was the method of communication in 88% (7 of 8) of these cases, while 12% (1 of 8) were carried out over the phone. Reasons for admissions were severe abdominal pain, hypotension, unstable angina / suspected myocardial infarction or a suspected schizophrenic episode.

Conclusions:

Most scheduled and unscheduled consultations did not require a subsequent patient transport to external healthcare providers. Using telemedicine services allowed a prompt patient-physician encounter with the possibility to refer patients to other specialties or to admit them to a hospital if necessary.