The Expert Patients Program in Prison

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The Expert Patients Program in Prison Claire Gately Andy Bowen Anne Kennedy Wendy Macdonald Anne Rogers

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Policy Context Historically social insurance in detainment facilities composed outside of the NHS Long standing level headed discussion about melding with NHS (Home Office, 1964; 1979; 1990) Inspectorate of Prisons (1996) Prisoner or Patient? 'The Future Organization of Prison Health Care' (DoH 1999) From April 2006 all Prison Health Care will be authorized by PCTs

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The Burden of Chronic Disease… 60% of grown-ups in England report a perpetual wellbeing issue (NatPaCT site) The requirement for Self-Care? Self-Care as a method for overseeing request Saving Lives: Our Healthier Nation (DOH, 1999)

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A Window of Opportunity… Poorer physical and emotional wellness 80% of detainees smoke High rate of psychological well-being issues 48% reported long-standing sickness or inability Low levels of wellbeing proficiency (Bridgwood and Malbon, 1995) Lifestyles that put them a danger of sick wellbeing High clients of administrations 3 times more prone to counsel a specialist get inpatient mind no less than 10 times as much of the time (Marshall et al, 2001)

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What is The Expert Patients Program? Self-Management Program 6 Consecutive Weekly Sessions Lay Led EPP utilizes: Skills authority Role Modeling Social Persuasion Reinterpretation of Symptoms to impact changes to self-viability

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Relaxation Better breathing Healthy eating and sustenance Exercise, how to assemble levels of wellness, adaptability and quality How to impart all the more successfully Making educated choices Dealing with outrage, fear, disappointment, detachment, weakness and despondency Using critical thinking abilities How to make arrangements that function for people Working with medicinal services experts Topics Covered

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Methodology Qualitative Methodology - semi-organized meetings Exploration of living with long haul condition & experience of EPP 2 Category C Male Training Prison X - 11 Pre & 8 Post EPP interviews (April and June 2005) Prison Y – 2 Post-Interviews just (January 2004) information gathered as a major aspect of bigger process assessment included as freak case

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Participants Mean Age = 41 years (extend = 30-66) Range of Chronic Conditions i.e. Cerebral Palsy, Diabetes, Psoriasis, Asthma, Back Problems, High Blood Pressure 7 individuals had different grumblings

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Impact of Prison on Management of Long Term Condition Unconducive environment Regain control

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Impact of Prison on Management of Long Term Condition Unconducive environment Regain control Well I was a great deal heavier before I come to jail. I've lost around three stones since I come to jail. Jail's done a ton for me. Individuals may find that abnormal, however it has. I see the social insurance staff as and when I have to see them … I've had every one of the checks and clearly I get a MOT, you know, do an examination from time to time... [PXID 10, obesity]

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Experience of EPP For a few detainees - helped to strengthen positive components of self- management But for the most part - provided intrigue yet no "eureka" minutes - failed to satisfy desires - difficulty moving into jail environment - course mentors require more noteworthy jail learning

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Experience of EPP "You have the practice issue, I mean clearly we're on a wing, you can't go out strolling when you like, then you got onto the nourishment business and you're in no genuine control of your eating routine, it's, you do get a decision however it's… I'll give you an illustration like your 3 bits of natural product that should have day by day, I mean it's things like that that are simply inconceivable so… It would it say it wasn't, wasn't really custom-made for jail." [PXID7 living with High circulatory strain, a hernia and back pain]

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Maintaining a Healthy Lifestyle Diet – Healthier Option?

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Maintaining a Healthy Lifestyle Diet – Healthier Option? "There's not a ton you can do truly. You get a menu slip a fortnight before you get your dinner, and what's on that menu, you must pick. At that point it's not the best of nourishment. I mean I know it should be a position of discipline, yet I mean I wouldn't give the nourishment in here to my pooch to be completely forthright with you. Not all suppers, a portion of the dinners are decent however by far most of them, I wouldn't sustain them to my pooch. It's basically chips at the same time. Things like beefburgers, frankfurters, you know, them, things that Jamie Oliver were on about on the television… And you contemplate internally, no doubt you come up here and you have Jane on one hand saying, "Admirably you know, watch your eating routine". And after that you do a reversal down to your wing and you get your menu and you think, well by what method would I be able to watch my eating routine?" [PXID 6, Diabetes and psoriasis]

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Maintaining a Healthy Lifestyle Exercise Aware of the advantages Restricted open doors Closed versus open Competition for spots Competing Priorities

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Negotiating Access Management of Medication

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Negotiating Access Management of Medication Well it took them four months to give me the balm to hold my psoriasis under control, and they were giving me stuff they were utilizing when I was, a child ten years of age. Indeed, and after so long your body gets accustomed to it and it just produces no results. What's more, this is the thing that I were attempting to disclose to the specialist and he… what got me is, the point at which I let him know the name of it, cos I couldn't recollect the name of it, cos I've had that numerous medicines, so I proved unable, yet I rang the missus, "Would you be able to let me know what the cream resemble?" And she let me know, and I went and seen him and he found it in their, the book, and the main words out of his mouth were, "Well it's £60, you can't have that". [PXID 6, Diabetes and psoriasis]

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Prisoner versus Patient Treated as Prisoners 1 st

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Prisoner versus Patient Treated as Prisoners 1 st "A greater amount of the minding accentuation. Toward the day's end, whether you're a detainee or not, you're still an individual and in the event that you are honest to goodness with a disease, you ought to be seen, you ought to have your medicinal services… I know it's moderate outside there, yet at any rate you ought to be on an indistinguishable level from out there, as in here, however we're most certainly not. We're behind." [PXID 10, Obesity]

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Prisoner versus Patient Priority to be given to Genuine Cases

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Prisoner versus Patient Priority to be given to Genuine Cases "However I do discover there's an, on the off chance that you need to call it, a culture or a disposition, an undercurrent inside staff on the restorative side truly in light of the fact that they have such a large number of fellows that come faking disease to escape work, they're all tarred with a similar brush, similar to I say conveyed down to the least regular level and not regarded as a person." [PXID1, Cerebral Palsy]

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Access to Health Care Professionals Triage postpones contact

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Access to Health Care Professionals Triage defers contact "I mean, I once wound up with about having pneumonia. Since, you know, the triage nurture continued palming me off with, letting me know it were only a frosty and I had a, somewhat of a, you know, a mid-section disease and it'll wear off, you comprehend what I mean. And after that when in the long run I got to see the specialist, the specialist reprimanded me for not, you know, seeing him prior, you realize what I mean… " [PXID4, Back injury]

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Conclusions Opportunity to address wellbeing needs But not interested in EPP Barriers to more beneficial way of life being received Tension - Patient focused versus observation No voice in specialist persistent relationship

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Implications Awareness of the self administration exercises accomplished reasonably Health experts to adventure facilitators Equivalent care = tolerant focused practice Patient not detainee