Keywords: primary care, health care of prison inmates, video consultation, secondary care referral, hospital admission
In comparison, prison inmates are at a higher risk for drug abuse, psychiatric or infectious diseases. Although intramural health has to be equivalent to extramural services, prison inmates have yet less access to specialized health care services. Often, a transport to the nearest extramural medical facility is resource-intensive. Video consultations may offer the chance to deliver cost-effective health care for those patients.
How often and why are referrals to secondary care and hospital admissions needed when a scheduled or unscheduled video consultation is offered at a prison?
In five German prisons, a pilot project was conducted in order to assess feasibility, acceptance and consultation reasons of primary care and psychiatric video consultations between June and December 2018. This analysis includes the data of 436 consultations from June 2018 to February 2019 and focuses on referral and admission rates, as well as reasons.
Most consultation were scheduled (341/436). In 67,4% (294/436) of all consultations the patient was asked to come back if symptoms persisted or got worse. In 26,6% (116/436) a follow up appointment with the video consultant or prison physician was scheduled. A referral to other specialties, most often psychiatry, was necessary in 3,9% (17/436) of the cases. Only in 1,8% (8/436) a hospital admission was needed. Usually (7/8) an admission was the result of an unscheduled consultation and video was used in 87% (7/8). Reasons for admissions were severe abdominal pain, hypotension, unstable angina / suspected myocardial infarction or a suspected schizophrenic episode.
Most scheduled and unscheduled consultations did not require a subsequent patient transport to external healthcare providers. Using telemedicine allowed a prompt consultation with the possibility to refer patients to other specialties or hospitalize them when necessary.
Points for discussion:
1.) Compared to a face-to-face consultation will video consultations more likely lead to under-, over- or incorrect treatment? Or is there no difference?
2.) In which settings would you consider video consultations as an adequate health care solution?
3.) What is the scientific as well as the health care impact of video consultations in future?