The need to improve health care in prisons

Fernandes, Luiz Henrique; Alvarenga, Carlos Willie; Santos, Luciane Loures dos; Pazin Filho, Antonio

doi:10.1590/S0034-8910.2014048004934

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Sumário

Original Articles • Rev. Saúde Pública 48 (2) • Apr 2014 • https://doi.org/10.1590/S0034-8910.2014048004934 copy

The need to improve health care in prisons

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To analyze physical structure, working conditions of health professionals and outline of the procedures established in prisons.

METHODS

We analyzed 34 provisional detention centers and 69 male and six female prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A self-applied instrument was developed to collect quantitative data on the characteristics of health care structure, equipment and personnel in prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and Chi-square or Fisher’s tests were used to compare categorical and continuous variables, respectively, between the groups.

RESULTS

The main problems were delays in the results of laboratory tests and imaging. With respect to the teams, it was observed that a large majority were in conditions close to those proposed by the Bipartite Commission 2013 but without improvement being reflected in the indicators. With respect to the process, more than 60.0% of prisons located in small towns do not have the structural conditions to ensure secondary or tertiary health care for the continuity of treatment.

CONCLUSIONS

This profile of prisons in the country can be used for planning and monitoring future actions for the continuous improvement of healthcare processes.

Prisons, organization & administration; Health Programs and Plans; Patient Care Team; Occupational Risks

Profession	N	RC (34)		PU MASC (69)		PU FEM (6)
		n^c	%/IQ^d	n	%/IQ	n	%/IQ
Doctor	At least 1 professional^a	21	61.7	54	78.2	5	83.3
	n/1,000 inmates^b	0.8	0;1.1	1	0.6;2.1	1.1	0.7;2.4
Dental surgeon	At least 1 professional	28	82.3	58	84.0	5	83.3
	n/1,000 inmates	1	0.6;1.6	0.9	0.7;1.7	1.1	0.7;2.4
Psychiatrist	At least 1 professional	12	35.3	36	52.1	6	100
	n/1,000 inmates	0	0;0.6	0	0;0.8	1.1	0.3;1.2
Nurse	At least 1 professional	23	67.6	47	68.1	4	66.6
	n/1,000 inmates	0.8	0;1.5	1.01	0;2.4	0.9	0;2.5
Nursing assistant	At least 1 professional	31	91.2	62	89.8	5	83.3
	n/1,000 inmates	3.3	2.7;5.0	3.5	2.5;4.9	7.4	4.4;11.1
Psychologist	At least 1 professional	22	64.7	55	79.7	4	66.6
	n/1,000 inmates	0.71	0;1.6	1.4	0.7;2.4	1.8	0;2.6
Social worker	At least 1 professional	25	73.5	60	86.9	5	83.3
	n/1,000 inmates	0.9	0.5;1.6	1.6	0.8;2.7	2.9	1.8;6.2

Category	RC (34)		PU MASC (69)		PU FEM (6)
	n	%/IQ^a	n	%/IQ	n	%/IQ
A – Minor illness (e.g., headache, cold, skin problems)
Not covered	1	3	1	1.5	0	0
Partially	9	27.2	18	26.8	0	0
Totally	23	69.7	48	71.6	6	100
B – Other diseases (e.g., cardiovascular disease, control of risk factors, infections)
Sexually transmitted diseases	1.07	0.62;1.85	1.41	0.9;1.9	12.9	3.7;34.4
Leprosy	0	0;0.7	0	0;0.07	0	0;0
Tuberculosis	0.64	0.34;1.1	0.9	0.89;1.62	0.15	0.12;0.37
HAS	1.2	0.09;2.70	2.6	1.4;4.1	8.4	7.5;16.0
DM	0.51	0.21;0.87	0.7	0.47;1.07	1.37	0.86;2.25
Other	0	0;0.16	0	0;0.33	0.86	0.25;1.64
C - Obstetrics and gynecology
Not covered					0	0
Partially					3	50.0
Totally					3	50.0
D – Mental disorders
Not covered	2	5.9	4	5.8	1	16.6
Partially	18	52.9	32	45.4	3	50.0
Totally	14	41.2	33	47.8	2	33.3
E – Alcohol and drug use
Alcohol
Alcohol prohibited – no problem exists	11	61.1	39	83.0	2	66.6
Only a problem upon admission	15	68.2	12	60.0	3	75.0
Constant problem	1	2.9	8	11.6	0	0
Assessed on admission	22	66.6	34	50.0	5	83.3
Treatment offered	10	31.2	15	23.1	2	40.0
Drugs
Totally	4	11.7	2	2.9	1	16.6
Partially	15	44.1	22	31.9	3	50.0
Serious cases	13	38.2	41	59.4	1	16.6
NR	2	5.9	4	5.8	1	16.6
Assessed on admission	25	73.5	46	67.6	5	83.3
Treatment offered	18	56.2	32	49.2	3	60.0
F – Health promotion
Assessed on admission	31	96.9	61	93.8	5	83.3
Type of evaluation
Clinical only	13	38.2	32	46.4	2	33.3
clinical (complemented if indicated)	18	52.9	30	43.5	2	33.3
clinical + laboratory + imaging	3	8.8	7	10.1	2	33.3
Routine vaccination in the unit	31	91.2	64	94.1	4	66.6
Types of vaccine administered
MMR	10	29.4	20	29.0	2	33.3
Tetanus	6	17.6	8	11.6	0	0
Yellow fever	18	52.9	18	26.1	2	33.3
Flu	16	47.0	58	84.0	3	50.0
H1N1	0	0	4	5.8	0	0
Tetanus + Diphtheria	17	50.0	29	42.0	2	33.3
Hepatitis	14	41.2	39	56.5	3	50.0
Agreements/Partnerships	9	27.7	23	33.8	4	66.6
Disabled
Wheelchairs/Crutches	26	76.4	53	76.8	3	50.0
Visual	13	38.2	35	50.7	4	66.6
Auditory	13	38.2	18	26.1	3	50.0
Speech	12	35.3	15	21.7	1	16.6

Flow parameters	RC (34)		PU MASC (69)		PU FEM (6)
Flow parameters	n	%	n	%	n	%
Health care	33	97,0	98.5	6,0	6	100
Secondary referral	7	20.6	5	0,0	0	0
Tertiary referral	10	29.4	32	2,0	2	23.3
Emergency	25	73.5	50	6,0	6	100
Mode of referral
Regulation	15	44.4	43	4,0	4	66.6
Direct contact	16	47,0	34	1,0	1	16.6
Other	8	23.5	6	1,0	1	16.6
Satisfaction with mode of referral
No	11	32.3	40	4,0	4	66.7
Yes	21	61.7	25	1,0	1	16.6
No response	2	5.9	4	1,0	1	16.6
Problems in referral
No escort available	21	61.7	53	3,0	3	50,0
No ambulance available	5	14.7	20	1,0	1	16.6
No receiving unit available	5	17.7	22	3,0	3	50,0
Other transfer problems	6	17.6	12	3,0	3	50,0

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence
: Antonio Pazin-Filho R. Bernardino de Campos, 1000 14015-130 Ribeirão Preto, SP, Brasil E-mail: apazin@fmrp.usp.br