To the Editor

There are currently ~83,430 prisoners in England and Wales (as of May 2018), representing a four-fold increase since 1990 [1]. Although prisoners are at a higher risk of health issues [2,3,4], there are few studies exploring their need for ophthalmic care, particularly focusing on their ability to access these services and the impact of any restriction.

In this retrospective study, 163 incarcerated patients at a tertiary ophthalmic unit were identified through electronic medical records and their attendance records and medical notes were reviewed. There were a total of 1398 appointments (1284 were clinic appointments and 114 appointments were for procedures or surgeries). Mean follow up was 17.8 months with an average of 3.8 hospital appointments. Basic patient demographics are shown in Table 1. For outpatient appointments, patients failed to attend 556 of 1284 appointments (43.3%); of these 188 were did not attends (14.6%) and 371 were patient cancellations (28.9%). Each prisoner had an 83.4% chance of failing to attend at least one appointment over course of his/her follow up. After failing to attend one appointment, there is a 72.6% chance that the patient will fail to attend at least another. 255 appointments were re-arranged and subsequently attended with a median delay of 31 days (inter-quartile range 14.0–62.8). The magnitude of delay of 1.46 (inter-quartile range 1.17–2.18)- meaning that patients on average had to wait 46% longer than planned to be seen. Of the 114 procedures episodes, 21 were unattended (18.4%). When the procedures were rearranged, there was a median delay of 14 days (range 4–43) and a median magnitude of delay of 1.58 (range 1.1–4).

Table 1 Patient demographics.
Full size table

Overall, 55.2% (90/163) of all prisoner patients were lost to follow up. Notes review highlighted 15 cases where delay in review could have resulted in harm (Table 2).

Table 2 Cases of potential exposure to harm.
Full size table

In conclusion, our study shows that prisoner patients experience very poor access to hospital healthcare and has a potentially high rate of exposure to harm. This potentially represents a systematic compromise of care in this particular patient group.