E010 Health inequalities facing the prisoner population: what can a rheumatology department do?
Year: 2025
Type: conference-abstract
Abstract: Background/Aims Prisoners face significant health inequalities in accessing healthcare, resulting in poorer health outcomes compared to the general population. Research indicates that prisoners miss outpatient appointments at double the rate of the general population, primarily due to socioeconomic and systemic barriers, including poor communication and chronic understaffing in prisons. This quality improvement project investigates prisoners’ attendance rates for rheumatology clinics at Minerva Health Centre and identifies factors contributing to non-attendance. Methods In April 2024 a search was undertaken on the electronic patient record to identify patients currently imprisoned across three designated facilities who received rheumatology care over the last five years. Demographic and appointment history data were compiled, categorising attendance-related factors into patient-related, prison-related, provider-related, other, and unknown. The patient pathway was mapped to understand how this differed to patients not in prison and a driver diagram produced to identify opportunities to improve the patient journey. Results Fifteen patients were identified, all were male, mean age 42 years, (age range 26-71 years) and 7 had been diagnosed with inflammatory arthritis. A total of 56 appointments were mapped, revealing a 44.6% attendance rate and identifying 55.4% of appointments as missed, cancelled, or rescheduled. Factors influencing non-attendance were categorised: 6 patient-related, 9 prison-related, 1 provider-related, and 12 unknown. Of 31 missed appointments, 8 were due to short staffing or transport issues, and 5 due to patient refusal. Only 1 appointment was rescheduled by Minerva while 8 were rescheduled by the prison. The time of appointments, staffing shortages and prison transport were identified as factors that influenced attendance. Mapping of the patient pathway identified a number of differences to patients not imprisoned including how appointments are booked, text reminders and access to the telephone advice line. To address these issues the team has now implemented a number of changes. Early morning appointments are avoided, appointments are booked directly with the prison medical team who are also contacted one week before to confirm patient can still attend. Conclusion This project identified a small number of patients who are experiencing significant challenges to accessing rheumatology care due to current pathways and processes. Using quality improvement methodology, a number of changes have been implemented that will hopefully improve attendance and subsequent health outcomes for this vulnerable population. The small sample size and reliance on historical data are acknowledged as limitations and the service are keen to involve patients in future discussions. The team are meeting with the Prison Medical Teams to further discuss these findings and understand if there are other changes that can be implemented. One consideration is the option of switching to a remote appointment if there are logistical issues on the day that mean a prisoner cannot attend. Disclosure N. Abdou: None. S. Fish: None. A. Madan: None. E. MacPhie: None.
Source: Rheumatology
Language: English
Subfield: Sociology and Political Science
Field: Social Sciences
Domain: Social Sciences
Open Access status: bronze
OpenAlex ID: W4409899485