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Standards for health services in Australian prisons

Criterion 1.5.1 Continuity of comprehensive care

Our health service facilitates continuity of comprehensive care to patients.


Indicators

A. Our health service has strategies or policies that support continuity of comprehensive care (interview, document review).


Explanation

Health services in prisons provide patient centred, continuing, comprehensive and coordinated primary care (including mental health and dental healthcare) and it is important that patients have the opportunity to develop an ongoing relationship with the service while they are in the prison. Continuity is the degree to which a series of discrete healthcare events is experienced by the patient as coherent and connected, and consistent with the patient’s medical needs and personal context. Continuity of care is distinguished from other attributes of care by two core elements – care over time and the focus on individual patients.

Continuity of care begins when a prisoner is received into the prison and screened for current medications, chronic health concerns and other events critical to the management of their healthcare. The processes and procedures the health service has in place to monitor and record relevant health information for each patient is an important factor in maintaining continuity of care.

The Standard guidelines for corrections in Australia33 stipulate that a prisoner is to be medically examined by a suitably qualified health professional within 24 hours of being received into the prison. If a prisoner has a pre-existing plan for the management of a particular condition, health service staff are encouraged to maintain the established care plan until such a time that a full assessment can be conducted.

Decisions need to be made on a case-by-case basis as to the appropriateness of requesting records from external health providers to assist in the ongoing care of a patient while they are in the prison. Bearing in mind that some patients will not want external health providers to know of their imprisonment, the patient needs to provide consent for such requests to be made.

In general, subject to the patient’s consent, it is advisable for a medical practitioner to confirm medications prescribed by a colleague in the community before the medications are prescribed again within the prison setting.

Prisoners may be frequently and rapidly transferred to alternative locations, compromising the continuity of care received from a single health service. To ensure continuity of care across health services in different prisons, health service staff need to develop a routine procedure for the way in which health information is transferred to a new location.

Discharge planning protocols should be organised by the health service and discharge plans should be documented in the patient health record at the time a patient leaves the facility whether by transfer to an alternative prison or on release into the community.

There are a number of types of continuity.34

  • The sense of affiliation between the patient and their health professional (‘my doctor’ ‘my nurse’, ‘my psychologist’ ‘my dentist’ or ‘my patient’), sometimes called ‘relational continuity’, which is the focus of Criterion 1.5.2: Continuity of the therapeutic relationship
  • Consistency of care by the various people involved in a patient’s care (ie. not working at ‘cross purposes’), sometimes called ‘management continuity’, which is the focus of Criterion 1.5.3: Consistent approach
  • Continuity of information across healthcare events, particularly through documentation, handover and review of notes from previous consultations, sometimes called ‘informational continuity’, which is the focus of Criterion 1.5.4: System for follow up of tests and results.

For people incarcerated in Australian prisons, health services act as coordinators of all healthcare services and as patient advocates. Patients in prisons have a restricted capacity to choose healthcare providers and are reliant on a health service to provide or coordinate their healthcare including mental healthcare, specialist healthcare, dental healthcare, allied healthcare and emergency healthcare. As such, coordination and continuity of comprehensive care for these patients is critical.

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