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Utilising a nurse navigator model of care to improve prisoner health care and reduce prisoner presentations to a tertiary emergency department

      Abstract

      Background

      Prisoners are a vulnerable population requiring complex care interventions in challenging environments, particularly around provision of emergency care. The aim of this study was to explore the effectiveness of a Nurse Navigator (NN) -led prisoner intervention from the perspective of the emergency department.

      Methods

      This study undertook a retrospective analysis of the prisoner presentations to a public emergency department. It used time-series analysis of publicly available deidentified data, collected during standard care evaluation, to explore the impact of this unique care model over 24 months (12-pre and 12-post). Synthesis of documents pertaining to this NN model of care provide a summary of key initiatives and interventions.

      Results

      With the introduction of NN, the rate of change of yearly prisoner presentations dropped from + 32.8% to − 2.7%. Interrupted time-series analysis on emergency department presentations per 1000 prisoners in custody confirmed a postintervention level drop of 15.1% (rate ratio 0.849; 95% CI 0.755–0.954) followed by a period of downward trending of presentations resulting in an absolute drop of 31.5% in twelve months (rate ratio 0.685; 95% CI 0.556–0.843).

      Conclusions

      The bundle of capacity-building initiatives instigated by the NN appear to have contributed to a reduction of prisoner presentations.

      Keywords

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      References

        • Kinner S.A.
        • Young J.T.
        Understanding and improving the health of people who experience incarceration: an overview and synthesis.
        Epidemiologic Rev. 2018; 40: 4-11https://doi.org/10.1093/epirev/mxx018
        • Kinner S.A.
        • Young J.T.
        • Carroll M.
        The pivotal role of primary care in meeting the health needs of people recently released from prison.
        Austral Psych. 2015; 23: 650-653https://doi.org/10.1177/1039856215613008
      1. Australian Institute of Health and Welfare (AIHW). The health of Australia’s prisoners 2018. Canberra, Australia: Australian Institute of Health and Welfare; 2019. Contract No.: Cat. no. PHE 246.

      2. PriceWaterhouseCoopers. Offender Health Services Review Final Report. 2018.

        • Kinner S.A.
        • Williams D.
        • Gallagher C.A.
        From knowledge to action: establishing an international network for justice health.
        J Correctional Health Care. 2011; 17: 183-186https://doi.org/10.1177/1078345810397317
      3. Australian Bureau of Statistics. Prisoners in Australia, Queensland. Canberra Australia; 2009.

      4. Davies M, Rolewicz L, Schlepper L and Fagunwa F. Locked out? Prisoners' use of hospital care. Nuffield Trust; 2020.

        • Gaston S.
        Vulnerable prisoners: dementia and the impact on prisoners, staff and the correctional setting.
        Collegian. 2018; 25: 241-246https://doi.org/10.1016/j.colegn.2017.05.004
      5. Ritacco KN. Healthcare in Prisons: Thesis, Northern Illinois University; 2019.

        • Harel N.
        • Moskovitch J.T.
        • Weiland T.J.
        • Augello M.R.
        Common emergency department presenting complaints of prisoners: a systematic review.
        EMA. 2019; 31: 183-192https://doi.org/10.1111/1742-6723.13161
        • Sonmez B.M.
        • Yilmaz F.
        • Iscanli M.D.
        • Yel C.
        • Demir A.
        • Ozdemir M.
        • et al.
        Prisoners seeking healthcare in emergency department.
        J Pakistan Med Assoc. 2020; : 1-15https://doi.org/10.47391/JPMA.1072
        • Ross J.
        • Field C.
        • Kaye S.
        • Bowman J.
        Prevalence and correlates of low self-reported physical health status among prisoners in New South Wales, Australia.
        Int J Prisoner Health. 2019; https://doi.org/10.1108/IJPH-06-2018-0039
        • Crilly J.
        • Johnston A.N.
        • Wallis M.
        • Polong‐Brown J.
        • Heffernan E.
        • Fitzgerald G.
        • et al.
        Clinical characteristics and outcomes of patient presentations to the emergency department via police: a scoping review.
        EMA. 2019; 31: 506-515https://doi.org/10.1111/1742-6723.13300
        • Tuinema J.
        • Orkin A.M.
        • Cheng S.Y.
        • Fung K.
        • Kouyoumdjian F.G.
        Emergency department use in people who experience imprisonment in Ontario, Canada.
        Canad J Emerg Med. 2020; 22: 232-240https://doi.org/10.1017/cem.2019.401
      6. Golembeski C, Irfan A, Williams B and Venters H. Covid-19 shows us that prison healthcare is in dire need of reform 2020 [Available from: https://blogs.lse.ac.uk/usappblog/2020/06/01/covid-19-shows-us-that-prison-healthcare-is-in-dire-need-of-reform/.

      7. Queensland Correctional Services. Queensland Correctional Services Annual Report 2017–2018. Queensland: The State of Queensland; 2018.

      8. Queensland Correctional Services. Queensland Correctional Services Annual Report 2018–2019. Queensland: The State of Queensland; 2019.

      9. Australian Institute of Health and Welfare (AIHW). The health of Australia’s prisoners 2015. Canberra, Australia: Australian Institute of Health and Welfare; 2015. Contract No.: Cat. no. PHE 207.

        • Sridhar S.
        • Cornish R.
        • Fazel S.
        The costs of healthcare in prison and custody: systematic review of current estimates and proposed guidelines for future reporting.
        Frontiers Psychiatry. 2018; 9: 716https://doi.org/10.3389/fpsyt.2018.00716
        • Awofeso N.
        Making prison health care more efficient.
        BMJ. 2005; 331: 248-249https://doi.org/10.1136/bmj.331.7511.248
        • Pauley T.
        • Matienzo J.
        • Ventura J.
        • Barbita J.
        Cost of an integrated care program to reduce ED visits during diabetic prisoner court hearings.
        J Correctional Health Care. 2017; 23: 283-296https://doi.org/10.1177/1078345817709804
        • Jacob R.
        • Wong M.L.
        • Hayhurst C.
        • Watson P.
        • Morrison C.
        Designing services for frequent attenders to the emergency department: a characterisation of this population to inform service design.
        Clinical Medicine. 2016; 16: 325https://doi.org/10.7861/clinmedicine.16-4-325
        • Georgiou M.
        • Jethwa J.
        Planning effective mental healthcare in prisons: findings from a national consultation on the Care Programme Approach in prisons.
        J Forensic Legal Med. 2021; 77102105https://doi.org/10.1016/j.jflm.2020.102105
        • Binnie V.
        • Le Brocque R.
        • Jessup M.
        • Johnston A.N.
        Adult frequent presentation to emergency departments and adverse childhood experiences: a scoping review.
        Aust Emer Care. 2020; https://doi.org/10.1016/j.auec.2020.11.002
        • Shannon B.
        • Pang R.
        • Jepson M.
        • Williams C.
        • Andrew N.
        • Smith K.
        • et al.
        What is the prevalence of frequent attendance to emergency departments and what is the impact on emergency department utilisation? A systematic review and meta-analysis.
        Internal Emerg Med. 2020; : 1-14https://doi.org/10.1007/s11739-020-02403-2
        • McMurray A.
        • Cooper H.
        The nurse navigator: an evolving model of care.
        Collegian. 2017; 24: 205-212https://doi.org/10.1016/j.colegn.2016.01.002
        • Byrne A.L.
        • Hegney D.
        • Harvey C.
        • Baldwin A.
        • Willis E.
        • Heard D.
        • et al.
        Exploring the nurse navigator role: a thematic analysis.
        J Nurs Manag. 2020; 28: 814-821https://doi.org/10.1111/jonm.12997
        • Gerdtz M.F.
        • Kapp S.
        • Michael E.
        • Prematunga R.
        • Virtue E.
        • Knott J.
        An evaluation of the use of management care plans for people who frequently attend the emergency department.
        Aust Emer Care. 2019; 22: 229-235https://doi.org/10.1016/j.auec.2019.08.001
      10. QLD_Government. Custodial offender snapshot – state-wide - Datasets | Open Data Portal | Queensland: Queensland Government; 2021 [Available from: https://www.data.qld.gov.au/dataset/custodial-offender-snapshot-statewide.

      11. . QHealth. Emergency Data Dictionary for Queensland public hospital emergency departments v1.0: Queensland Health; 2018 [updated Last checked: 19/07/2021. v3.1:[Available from: https://qheps.health.qld.gov.au/caru/data/collections/edc.

        • Bhaskaran K.
        • Gasparrini A.
        • Hajat S.
        • Smeeth L.
        • Armstrong B.
        Time series regression studies in environmental epidemiology.
        Int J Epidemiol. 2013; 42: 1187-1195https://doi.org/10.1093/ije/dyt092
        • Lagarde M.
        How to do (or not to do) … Assessing the impact of a policy change with routine longitudinal data.
        Health Policy Plan. 2011; 27: 76-83https://doi.org/10.1093/heapol/czr004
        • Lopez Bernal J.A.
        • Gasparrini A.
        • Artundo C.M.
        • McKee M.
        The effect of the late 2000s financial crisis on suicides in Spain: an interrupted time-series analysis.
        Europ J Public Health. 2013; 23: 732-736https://doi.org/10.1093/eurpub/ckt083
      12. Team RC. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2013 [Available from: http://www.R-project.org/.

        • Koester L.
        • Brenner J.M.
        • Goulette A.
        • Wojcik S.M.
        • Grant W.
        Inmate health care provided in an emergency department.
        J Correctional Health Care. 2017; 23: 157-161https://doi.org/10.1177/1078345817699595