• Kate McLintock, Robbie Foy, Krysia Canvin, Sue Bellass, Pip Hearty, Nat Wright, Marie Cunningham, Nicola Seanor, Laura Sheard, and Tracey Farragher.
• University of Leeds.
• Br J Gen Pract. 2023 Jul 1; 73 (suppl 1).

BackgroundPrisoners have considerable health needs, are relatively high users of health care and often die prematurely. Prison healthcare research has typically focused on specific problems such as substance misuse, but 'routine' primary care has received less attention. Strong primary care systems are associated with better population outcomes. Identifying inappropriate variations in care will inform strategies to close gaps in health care and reduce preventable deaths.AimTo explore variations in the quality of primary care for prisoners.MethodWe assessed achievement against 30 quality indicators examining different aspects of care in 13 prisons. We conducted repeated cross-sectional analyses of routinely recorded data from electronic health records across 2017-2020. Multi-level logistic regression models explored associations between indicator achievement and prison and prisoner characteristics.ResultsWe found marked variations in achievement between different indicators and different prisons. Achievement ranged from 0·2% of people with epilepsy coded as seizure-free, to 93·8% of people with diabetes having blood pressure checks, in the preceding year. Achievement improved over three years for 11 indicators and worsened for six, including declining antipsychotic monitoring and rising opioid prescribing. Achievement varied between prisons, from 1·93-fold for prescribing of gabapentinoids with no coded diagnosis of neuropathic pain (Odds Ratio (OR) range 0·67 to 1·29) to 21,610-fold for medicine reconciliation (OR range 0·45 to 9724·5). Shorter lengths of stay were frequently associated with lower achievement. Some associations between ethnicity and achievement were identified.ConclusionWe found substantial scope for improvement and marked variations in quality which were largely unaltered after adjustment for prison and prisoner characteristics.© British Journal of General Practice 2023.

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