背景:与普通人群相比,监狱囚犯吸毒和精神病的风险更高,以及传染性,疾病。尽管壁内保健必须等同于壁外服务,监狱囚犯获得初级和二级保健的机会较少。此外,并非每个监狱都经常配备医生。由于运输到最近的校外医疗机构通常是资源密集型的,视频咨询可以为监狱囚犯提供具有成本效益的医疗保健。
目的:本研究旨在量化在监狱中与家庭医生和精神科医生进行视频咨询时,对二级保健服务的转诊和住院的需求。
方法:在5个德国监狱中,进行了混合方法评估研究,以评估可行性,接受,以及与家庭医生和精神科医生进行视频咨询的原因。该分析使用来自这些咨询(2018年6月至2019年2月)的定量数据,以及2019年1月添加的第六所监狱的数据,重点是转诊和入院率。以及相遇的原因。
结果:在项目启动时,2499名囚犯被关押在6所监狱中。共有12名医生(3名女性家庭医生和7名男性家庭医生,共进行了435次视频咨询,和2名男性精神科医生在研究期间)。大多数是预定的咨询(341/435,78%)。在所有遭遇的68%(n=294)中,如果症状持续或恶化,则要求患者再次咨询医生.在26%(n=115)中,计划与视频顾问或监狱医生进行后续预约。转介其他专业,最常见的是精神病学,在4%(n=17)的病例中是必要的。仅在2%(n=8)的咨询中,需要住院。通常,入院是计划外咨询的结果,视频会议系统是88%(n=7)的通信方式,而12%(n=1)是通过电话进行的。入院的原因是严重的腹痛,低血压,不稳定型心绞痛或疑似心肌梗塞,或者疑似精神分裂症.
结论:大多数计划内和计划外的会诊不需要随后将患者运送到外部医疗保健提供者。使用远程医疗服务可以使患者与医生迅速相遇,从而有可能将患者转诊到其他专科或在必要时将其送往医院。
BACKGROUND: In comparison to the general population, prison inmates are at a higher risk for drug abuse and 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: This study aims 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 5 German prisons, a mixed methods evaluation study was conducted 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 sixth 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, and 2 male psychiatrists during the study period). The majority were scheduled consultations (341/435, 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 videoconferencing system was the method of communication in 88% (n=7) of these cases, while 12% (n=1) were carried out over the phone. Reasons for admissions were severe abdominal pain, hypotension, unstable angina or suspected myocardial infarction, or a suspected schizophrenic episode.
CONCLUSIONS: Most scheduled and unscheduled consultations did not require subsequent patient transport to external health care 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.