[Consensus for the management of infectious diseases among asylum seekers and detainees in the canton of Vaud]. / Consensus vaudois de prise en charge de maladies infectieuses auprès des requérants d'asile et détenus.

Our work develops procedures and useful tools for the screening, assessment and management of prevalent infectious or parasitic diseases (tuberculosis, measles, chickenpox, scabies, bed bugs) among asylum seekers and detainees in the canton of Vaud, populations living in similar closed settings. Its aim is to support health professionals in their work, to maintain the health of the target population and to protect the health of the community. Through a literature review and a focus group with experts, it is proposed to harmonize the existing procedures in asylum seekers centres end prisons of the canton of Vaud. The proposed decision algorithms are coherent with the recommendations of the literature and relevant in terms of public health and ethics, as well as feasible logistically and acceptable by the field health professionals.

Ce travail développe des procédures dans le cadre du dépistage et de la prise en charge de maladies infectieuses ou parasitaires prévalentes (tuberculose, rougeole, varicelle, gale, punaises de lit) chez les requérants d'asile et détenus du canton de Vaud, populations vivant dans des environnements similaires, afin de soutenir le personnel soignant dans son travail de terrain, veiller à la santé des personnes concernées et protéger la population locale. Il s'agit donc d'harmoniser, grâce à une revue de littérature et un focus group d'experts, les procédures existant dans les centres de requérants et de détenus vaudois en s'assurant que celles-ci correspondent aux recommandations de la littérature et soient pertinentes en termes de santé publique et d'éthique, ainsi que réalisables d'un point de vue logistique et acceptables par les équipes de terrain.

[Clinical situations in detention settings]. / Situations cliniques en milieu ­pénitentiaire.

Infectious diseases, substance use disorders, and psychiatric conditions are more prevalent in prisons than in the general population. There is relatively limited evidence regarding the medical management of non communicable diseases in prison settings. The clinical cases described in this article highlight specific dimensions to be considered when practicing medicine in detention settings : multidisciplinary work ; regular voluntary screening for infectious diseases that are prevalent in this population ; management of non communicable diseases ; availability of medical protocols for specific clinical situations (for example, body-packing) ; or proactive screening for mental health disorders.

La prévalence des maladies infectieuses, des troubles de la dépendance et des pathologies psychiatriques est plus importante en prison que dans la population générale. Il existe encore peu d'évidences quant à la prise en charge optimale des maladies non transmissibles dans ces contextes. Les vignettes cliniques discutées dans cet article mettent en lumière certaines dimensions liées à l'exercice de la médecine en milieu carcéral : travailler en interdisciplinarité ; proposer le dépistage régulier de certaines maladies infectieuses fréquentes dans cette population ; être d­avantage attentif à la prise en charge des maladies non transmissibles ; élaborer des directives propres à des situations particulières (telles que la dissimulation intracorporelle de substances illicites) ou dépister de manière proactive les troubles de la ­santé mentale.

Healthcare in a pure gatekeeping system: utilization of primary, mental and emergency care in the prison population over time.

BACKGROUND: This study investigates the prisoner and prison-level factors associated with healthcare utilization (HCU) and the dynamic effects of previous HCU and health events. We analyze administrative data collected on annual adult prisoner-stay HCU (n = 10,136) including physical and mental chronic disease diagnoses, acute health events, penal circumstances and prison-level factors between 2013 and 2017 in 4 prisons of Canton of Vaud, Switzerland. Utilization of four types of health services: primary, nursing, mental and emergency care; are assessed using multivariate and multi-level negative binomial regressions with fixed/random effects and dynamic models conditional on prior HCU and lagged health events. RESULTS: In a prison setting with health screening on detention, removal of financial barriers to care and a nurse-led gatekeeping system, we find that health status, socio-demographic characteristics, penal history, and the prison environment are associated with HCU overtime. After controlling for chronic and past acute illnesses, female prisoners have higher HCU, younger adults more emergencies, and prisoners from Africa, Eastern Europe, and the Americas lower HCU. New prisoners, pretrial detainees or repeat offenders utilize more all types of care. Overcrowding increases primary care but reduces utilization of mental and emergency services. Higher expenditure on medical staff resources is associated with more primary care visits and less emergency visits. The dynamics of HCU across types of care shows persistence over time related to emergency use, previous somatic acute illnesses, and acting out events. There is also evidence of substitution between psychiatric and primary care. CONCLUSIONS: The prison healthcare system provides an opportunity to diagnose and treat unmet health needs for a marginalized population. Access to psychiatric and chronic disease management during incarceration and prevention of emergency or acute events can reduce future demand for care. Prioritization of high-risk patients and continuity of care inside and outside of prisons may reduce public health pressures in the criminal system. The prison environment and prisoners' penal circumstances impacts healthcare utilization, suggesting better coordination between the criminal justice and prison health systems is required.