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The delivery of Primary Health Care services in Australian prisons is an increasingly costly business, with one in three prison entrants in 2018 self-reporting a chronic health condition, and one in four on medication for a mental health issue, according to the Australian Institute of Health and Welfare.
Central Australia Health Service (CAHS) and Top End Health Service (TEHS) have been investigating more efficient ways to deliver high quality health services to a growing inmate population and have recently begun rolling out a number of initiatives to reduce constraints on staff resources and budgets.
Ahead of the Correctional Services Healthcare Summit, District Managers Dy Kelaart of CAHS and Priscilla Moore of TEHS, spoke to Informa about some of these new cost-saving measures.
Telehealth & specialist outreach services
Routine appointments with dental, ophthalmic, radiology, podiatrists, cardiologists and other specialists used to require an out-of-town visit to health facilities, an approximate 60 kilometre round trip from some correctional centres. Naturally, this would place a significant strain on human resources.
More recently, however, the agencies have begun to expand specialist outreach services and more widely adopt telehealth services, whenever possible.
“Promoting expanded onsite specialist services has improved access to all types of healthcare for our clients, and the Primary Health Care team are actively working to further improve access to onsite specialist care”, said Priscilla.
Current services providing Telehealth to Prison services include Renal, Viral Hepatitis, Endocrinology, Orthopaedic, Neurosurgery, General surgical and pre admission surgical. So far, the expansion of telehealth and specialist outreach services has seen tremendous cost savings.
An average 25 clients are seen each month via Telehealth, with an average cost saving of $370 per patient. In May 2019, Darwin Correctional Centre generated a cost saving to government of $9250 for telehealth.
“In the majority of cases, a Telehealth appointment is sufficient to give optimal patient outcomes. For cases where it is not, we are working hard to deploy more specialist outreach services to provide care within the correctional facilities”, said Dy.
Medication self-possession model
Prior to the introduction of new initiatives, medication rounds at the correctional centres would take approximately three hours to complete, placing a significant burden on staff resources.
CAHS and TEHS conducted a risk assessment of the gamut of medications routinely being consumed by the inmates and recognised the potential for many – excluding identified trafficable, heavy-duty, Schedule S4 or S8 antipsychotic drugs – to be self-possessed and self-administered by the prisoners.
Alice Springs has implemented the self-possession model across all sections – from low to maximum security – over the past 12 months and has been able to trim medication rounds down to just one hour. This been implemented without any major issues to date.
“Currently there are several hundred inmates that require regular medication intake and many of these drugs are chronic disease medications, which our risk assessment has deemed safe for self-possession and administration”, said Dy.
“In the Darwin Correctional Centre, out of all chronic disease medications in cycle, more than 60 percent of clients self-possess; and out of the 348 clients in medication categories deemed safe for self-possession, more than seventy percent are currently self-possessing” Priscilla added.
“We have now trialled the model, evaluated it, and it is working beautifully. We have demonstrated that it can work well and be managed safely”.
Priscilla and Dy will share further details of these plus other new initiatives the agencies are using to cut prisoner healthcare costs at Informa’s Correctional Services Healthcare Summit – due to take place 10-11 September 2019 in Melbourne.