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

Chantal Edge; Julie George; Georgia Black; Michelle Gallagher; Aftab Ala; Shamir Patel; Simon Edwards; Andrew Hayward

doi:10.1136/bmjopen-2019-035837

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

BMJ Open. 2020 Feb 18;10(2):e035837. doi: 10.1136/bmjopen-2019-035837.

Authors

Chantal Edge¹, Julie George², Georgia Black^{3

4}, Michelle Gallagher⁵, Aftab Ala⁵, Shamir Patel⁶, Simon Edwards⁷, Andrew Hayward^{3

8}

Affiliations

¹ Collaborative Centre for Inclusion Health, University College London, London, UK c.edge@ucl.ac.uk.
² Institute of Health Informatics, University College London, London, UK.
³ Collaborative Centre for Inclusion Health, University College London, London, UK.
⁴ Department of Applied Health Research, University College London, London, UK.
⁵ Gastroenterology and Hepatology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK.
⁶ Offender Care, Central and North West London NHS Foundation Trust, London, UK.
⁷ Diggory Division, Central and North West London NHS Foundation Trust, London, UK.
⁸ Institute of Epidemiology and Health Care, University College London, London, UK.

Abstract

Introduction: People in prison tend to experience poorer health, access to healthcare services and health outcomes than the general population. Use of video consultations (telemedicine) has been proven effective at improving the access, cost and quality of secondary care for prisoners in the USA and Australia. Implementation and use in English prison settings has been limited to date despite political drivers for change. We plan to research the implementation of a new prison-hospital telemedicine model in an English county to understand what factors drive or hinder implementation and whether the model can improve healthcare outcomes as demonstrated in other contextual settings.

Methods and analysis: We will undertake a hybrid type 2 implementation effectiveness study to gather evidence on both clinical and implementation outcomes. Data collection will be guided by the theoretical constructs of Normalisation Process Theory. We will prospectively collect data through: (1) prisoner/patient focus groups, interviews and questionnaires, (2) prison healthcare, hospital and wider prison staff interviews and questionnaires, (3) routine quality improvement and service evaluation data. Up to four prisons and three hospital settings in Surrey (England) will be included in the telemedicine research, dependent on their telemedicine readiness during the study period. Prisons proposed include male and female prisoners, remand (not yet sentenced) and sentenced individuals and different security categorisations. In addition, focus groups in five telemedicine naïve prisons will provide information on patient preconceptions and concerns surrounding telemedicine.

Ethics and dissemination: This study has received National Health Service Research Ethics Committee, Her Majesty's Prison and Probation Service National Research Committee and Health Research Authority approval. Dissemination of results will take place through peer-reviewed journals, conferences and existing health and justice networks.

Keywords: forensic medicine; internal medicine; protocols & guidelines; telemedicine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Comparative Effectiveness Research
England
Female
Focus Groups
Health Services Accessibility* / economics
Humans
Male
Prisoners*
Prisons
Secondary Care* / economics
State Medicine
Surveys and Questionnaires
Telemedicine*

Abstract

Publication types

MeSH terms

Grants and funding