Access to treatment in prison: an inventory of medication preparation and distribution approaches

Nguyen Toan Tran, Conceptualization , Data Curation , Formal Analysis , Investigation , Methodology , Visualization , Writing – Original Draft Preparation , Writing – Review & Editing , a, 1, 2 Dominique Pralong, Conceptualization , Formal Analysis , Methodology , Validation , Writing – Original Draft Preparation , 1 Anne-Dominique Secrétan, Conceptualization , Formal Analysis , Investigation , Methodology , Validation , Writing – Original Draft Preparation , 1 Audrey Renaud, Conceptualization , Formal Analysis , Investigation , Methodology , Validation , Visualization , Writing – Review & Editing , 1 Gérard Mary, Conceptualization , Formal Analysis , Investigation , Methodology , Validation , Visualization , Writing – Review & Editing , 1 Arnaud Nicholas, Conceptualization , Formal Analysis , Investigation , Methodology , Validation , Writing – Review & Editing , 1 Elisabeth Mouton, Formal Analysis , Investigation , Methodology , Project Administration , Supervision , Validation , Writing – Review & Editing , 1 Clémence Rubio, Conceptualization , Formal Analysis , Investigation , Methodology , Validation , Writing – Review & Editing , 1 Célestine Dubost, Conceptualization , Formal Analysis , Investigation , Validation , Writing – Review & Editing , 1 Francesco Meach, Conceptualization , Formal Analysis , Investigation , Validation , Writing – Review & Editing , 1 Anne-Claire Bréchet-Bachmann, Formal Analysis , Investigation , Validation , Writing – Review & Editing , 1 and Hans Wolff, Formal Analysis , Investigation , Resources , Supervision , Validation , Writing – Review & Editing 2, 3

Nguyen Toan Tran

1 Division of Health in Prison, Geneva University Hospitals and the University of Geneva, Chêne-Bourg, Switzerland, 1225, Switzerland

2 Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia

Dominique Pralong

1 Division of Health in Prison, Geneva University Hospitals and the University of Geneva, Chêne-Bourg, Switzerland, 1225, Switzerland

Anne-Dominique Secrétan

1 Division of Health in Prison, Geneva University Hospitals and the University of Geneva, Chêne-Bourg, Switzerland, 1225, Switzerland

Audrey Renaud

1 Division of Health in Prison, Geneva University Hospitals and the University of Geneva, Chêne-Bourg, Switzerland, 1225, Switzerland

Gérard Mary

1 Division of Health in Prison, Geneva University Hospitals and the University of Geneva, Chêne-Bourg, Switzerland, 1225, Switzerland

Arnaud Nicholas

1 Division of Health in Prison, Geneva University Hospitals and the University of Geneva, Chêne-Bourg, Switzerland, 1225, Switzerland

Elisabeth Mouton

1 Division of Health in Prison, Geneva University Hospitals and the University of Geneva, Chêne-Bourg, Switzerland, 1225, Switzerland

Clémence Rubio

1 Division of Health in Prison, Geneva University Hospitals and the University of Geneva, Chêne-Bourg, Switzerland, 1225, Switzerland

Célestine Dubost

1 Division of Health in Prison, Geneva University Hospitals and the University of Geneva, Chêne-Bourg, Switzerland, 1225, Switzerland

Francesco Meach

1 Division of Health in Prison, Geneva University Hospitals and the University of Geneva, Chêne-Bourg, Switzerland, 1225, Switzerland

Anne-Claire Bréchet-Bachmann

1 Division of Health in Prison, Geneva University Hospitals and the University of Geneva, Chêne-Bourg, Switzerland, 1225, Switzerland

Hans Wolff

2 Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia

3 European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), Council of Europe, Strasbourg, 67075, France

1 Division of Health in Prison, Geneva University Hospitals and the University of Geneva, Chêne-Bourg, Switzerland, 1225, Switzerland

2 Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia

3 European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), Council of Europe, Strasbourg, 67075, France

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Abstract

The preparation and distribution of medication in prisons or jails are critical for individuals to access their treatment. This process is resource-intensive for healthcare professionals and may violate principles of confidentiality, autonomy, respect, and dignity if non-qualified staff are involved. However, there are no published best practices on the topic. This report aims to bridge this gap by presenting the results of a mapping exercise on different models of medication preparation and delivery. Authors call upon healthcare professionals to enrich this live document to inform health services research further and improve access to prescribed medications for people experiencing incarceration.

Keywords: Access to medication, preparation, dispensing, detention, prison, autonomy, confidentiality, dignity

Background

Individuals experiencing incarceration carry a high burden of physical and mental health conditions 1– 4 . Clinical services operating in prisons and jails are vital in offering non-pharmacological and pharmacological interventions to treat, care for, and support incarcerated persons. Once prescribed, medications require coordinated preparation and delivery for individuals to access their treatment on time. The report of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) published in 1992 recommended that there should be appropriate supervision of the pharmacy and the distribution of medicines. Further, the preparation of medicines should always be entrusted to qualified staff (pharmacist/nurse, etc.) 5 . Therefore, medication preparation and distribution should only engage qualified healthcare professionals. This process is notably intensive and can take away resources from other clinically meaningful activities, such as individual patient visits and health promotion and prevention activities. In smaller detention facilities (less than 100 occupants), which usually have limited healthcare staff, prison officers or even prisoners can be involved in medication preparation and distribution 6 . Such practices violate the principles of confidentiality, autonomy, respect, dignity, and quality of care. CPT experts raised such concerns during recent visits in different European countries, where they observed a lack of respect for the 1992 recommendations of the CPT 7 . For instance, prison officers and incarcerated individuals were found in Greece to work as orderlies (i.e., persons trained in first aid and selected healthcare tasks, such as the delivery of medications, under the supervision of nurses) 8 . In Norway, although nurses were present daily, custodial officers had the duty to distribute prescribed medications 9 .

Best practices related to medication preparation and distribution in prison, and in particular in smaller facilities, could help inform the organization of healthcare service delivery that complies with quality of care, confidentiality, and other human rights principles. There is, however, a paucity of publication on the subject. The objective of this paper is to present a live inventory of different approaches to medication preparation and delivery in prisons.

Methods

First, we looked for published literature on different modalities of medication preparation and distribution. On 15 August 2019, we searched PubMed and Google Scholar for publications studying different approaches using search strings combining medical subject headings (MeSH) terms related to medication preparation, dispensing, and prison with terms related to best practices (i.e., pharmaceutical preparations AND prisons AND practice guidelines as topic). The review of titles and abstracts yielded no relevant articles, prompting us to extend our search to the grey literature by using Google Search, to no avail. Though our choice of keywords were limited, the lack of relevant publications yielded by our search suggests there may be paucity of research on this specific yet important operational aspect of health services management in prisons.

Second, we conducted a focus group discussion among our clinical staff from the Division of Health in Prison, which operates at the post-trial detention facility of La Brenaz in Geneva, Switzerland. On 22 August 2019, the Head of the unit facilitated a focus group discussion, which involved four female nurses, two male nurses, two internal medicine specialists (one female, one male), and a female psychiatrist. The discussion was guided by the care continuum of medication preparation, distribution, and self-administration and the “4Ws + H” lens (what, where, when, who, and how). We did not record the discussion but directly captured participants’ inputs on a whiteboard to help visualize the emerging mapping and catalyze additional contributions. Photographs of the whiteboard were taken and used to transcribe and further categorize the information in a Word document table ( Table 1 ). We consolidated the initial results with inputs from healthcare colleagues who could not attend the focus group discussion and validated the content of the table with participants of the focus group discussion and the Division Chief. The mapping drew from our work experience in prisons and visit to other facilities in Switzerland and various countries in Europe and North America. It was also informed by quality of care and operational considerations with a focus on reducing errors 10 and promoting key human rights principles, such as autonomy, confidentiality, respect, and dignity 11 .

Table 1.