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FORUM on Corrections Research
Use of Health Services by Offenders
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A recent study completed in the Prairie region focused on patterns of health service use among inmates.
The study replicated earlier research conducted in the Pacific region by Sheps and Schechter in 1984.
The survey was carried out in the nine Prairie federal institutions between May 29 and June 28,
1987. For the purpose of the study, a health service encounter was defined as an interaction between an inmate and a health care professional, including physicians, dentists, optometrists, dietitians, psychiatrists or nurses. Encounters could take place at the clinic, the wicket, or the inmate's cell. Clinic visits were defined as those for which inmates received some type of treatment or counselling. Wicket encounters, during which medications were dispensed, were excluded as well as those used for scheduling appointments. Cell visits were only included if a problem was presented and addressed. Over the one month period, 3,981 encounters were recorded. The distribution of visit times showed that wicket visits were most frequent during regular clinic hours. Results showed that the rate of encounters varied according to security level. The multi-level institutions, namely Saskatchewan Penitentiary and the Regional Psychiatric Centre, as well as Bowden minimum security institution, recorded the highest rates of health service use. The 10 most common complaints presented by inmates accounted for 48% of all complaints in the study. Anxiety disorders, back pains and headaches were the most common complaints, regardless of where the health service contact took place. It is noteworthy that injuries accounted for 7% of the reported problems. Fifty-eight percent of the encounters were made with nursing staff and 25% were with physicians. In terms of the outcomes of the encounters, 58% of the inmates were told to return as required, 18% were asked to return for follow-up, approximately 15 % were referred to other physicians, psychiatrists or specialists, and about 2% were admitted to the internal health care facility or to an outside hospital. Most encounters were considered necessary by professional staff; only 11 % of the encounters were viewed as unnecessary. The author suggested that the rate of unnecessary visits in the penitentiary would be comparable to the proportion of unnecessary visits to physicians offices in the community. Emergencies accounted for 2 % of the visits, urgent cases for 9%, and necessary (but not urgent) for 78 %. Interestingly, only 39% of the encounters involved treatment with medications. The 10 most frequent visitors in each institution registered between 12% and 27% of the visits. The 50 most frequent visitors in the nine institutions (3% of all visitors) accounted for 15% of the health service encounters in the Prairie region. The study confirms some of the findings of the earlier research conducted in the Pacific region. Both studies found that a small number of inmates initiated a large number of the services that were provided. Compared to the Pacific region, medications were used to a lesser extent in the Prairie region. One possibility is that inmates have less access to the wicket now, and as a result they are less likely to use it as a drugstore. In addition, there may have been changes in the philosophy of treatment over the intervening years between the two studies. Millar, J.M. Dr. (1988). Utilization of Health Care Services in the Prairie Region Federal Prisons. Health Care, Correctional Service of Canada, Prairie Regional Headquarters, Saskatoon, Sask. |
