Using telemedicine to improve access, cost and quality of secondary care for people in prison in England: A hybrid type 2 implementation effectiveness study

Chantal Edge*, Julie George, Georgia Black, Michelle Gallagher, Aftab Ala, Shamir Patel, Simon Edwards, Andrew Hayward

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Introduction People in prison tend to experience poorer health, access to healthcare services and health outcomes than the general population. Use of video consultations (telemedicine) has been proven effective at improving the access, cost and quality of secondary care for prisoners in the USA and Australia. Implementation and use in English prison settings has been limited to date despite political drivers for change. We plan to research the implementation of a new prison-hospital telemedicine model in an English county to understand what factors drive or hinder implementation and whether the model can improve healthcare outcomes as demonstrated in other contextual settings. Methods and analysis We will undertake a hybrid type 2 implementation effectiveness study to gather evidence on both clinical and implementation outcomes. Data collection will be guided by the theoretical constructs of Normalisation Process Theory. We will prospectively collect data through: (1) prisoner/patient focus groups, interviews and questionnaires, (2) prison healthcare, hospital and wider prison staff interviews and questionnaires, (3) routine quality improvement and service evaluation data. Up to four prisons and three hospital settings in Surrey (England) will be included in the telemedicine research, dependent on their telemedicine readiness during the study period. Prisons proposed include male and female prisoners, remand (not yet sentenced) and sentenced individuals and different security categorisations. In addition, focus groups in five telemedicine naïve prisons will provide information on patient preconceptions and concerns surrounding telemedicine. Ethics and dissemination This study has received National Health Service Research Ethics Committee, Her Majesty's Prison and Probation Service National Research Committee and Health Research Authority approval. Dissemination of results will take place through peer-reviewed journals, conferences and existing health and justice networks.

Original languageEnglish
Article number035837
JournalBMJ Open
Issue number2
Publication statusPublished - 18 Feb 2020
Externally publishedYes

Bibliographical note

Funding Information:
Contributors CE conceived the project. CE wrote the original research grant funding application and protocol, with methodological guidance and support from academic supervisors AH, JG and GB. SE, SP, MG, AA are senior clinicians within participating hospitals who have guided methodological considerations throughout and provide clinical supervision of the PhD student. SP and MG are named local principal investigators, AH is named Chief Investigator for the study for ethical approvals. CE is named Principal Investigator and PhD student. All authors reviewed and commented on the final draft of this protocol.

Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.


  • forensic medicine
  • internal medicine
  • protocols & guidelines
  • telemedicine


Dive into the research topics of 'Using telemedicine to improve access, cost and quality of secondary care for people in prison in England: A hybrid type 2 implementation effectiveness study'. Together they form a unique fingerprint.

Cite this