Implementation and Evaluation of a Telemedicine Program for Specialty Care in North Carolina Correctional Facilities

This cross-sectional study evaluates the implementation of a telemedicine program in North Carolina prisons based on responses from individuals who were incarcerated, health care practitioners, and telepresenters.


Introduction
More than 1.2 million adults are incarcerated in US prisons. 1 Although these individuals generally receive primary and urgent care within the prison facility, those who need more specialized care often need to leave the prison facility for health care at a local or regional health care facility, a process that is expensive and logistically challenging and may fragment care and pose security risks. In response to the COVID-19 pandemic, prison facilities necessarily limited movement of individuals who were incarcerated within and between facilities, 2 restricting their ability to access secondary and tertiary health care. The North Carolina Department of Public Safety, UNC Health, and University of North Carolina School of Medicine responded by expediting the implementation of a law passed in North Carolina to enable individuals who are incarcerated to receive specialty care via telemedicine. 3 The purpose of this study was to evaluate the implementation of a telemedicine program for specialty care in North Carolina prisons during the COVID-19 pandemic.

Methods
This cross-sectional study was deemed exempt from review by the University of North Carolina at We conducted a cross-sectional study of the use of telemedicine to deliver secondary and tertiary health care by specialist physicians, nurse practitioners, (NPs), and physician assistants (PAs) to individuals who were incarcerated within 55 North Carolina prison facilities. We procured and implemented telemedicine software and equipment, developed a telemedicine workflow, and trained administrative and nursing staff as telepresenters to schedule and assist with telemedicine visits. Likewise, we designated practitioners in each participating specialty to provide care via telemedicine, reassigned established patients who were incarcerated to those practitioners, built practitioner schedules, developed a scheduling web portal and referral triage process, and trained practitioners to perform telemedicine visits and document these encounters in the prison electronic health record.
Between June 1 and November 30, 2020, we distributed in-prison surveys for 1252 visits and collected 1584 surveys from patients (482 visits; response rate, 38.5%) and telemedicine presenters (739 visits; response rate, 59.0%). Patient race was self-identified and collected to assess whether there were racial disparities in telemedicine satisfaction. Additionally, we collected electronic surveys from practitioners at the end of each telemedicine shift, which covered 3232 visits performed by 60 Author affiliations and article information are listed at the end of this article. practitioners (316 telemedicine shifts; 58 practitioners [96.7%] among all participating practitioners completed Ն1 survey).
The survey instrument contained six 5-point scale questions regarding overall satisfaction (all participants), comfort using telemedicine technology (all participants), visit duration (patients only), explanation of treatment plan (patients only), quality of telemedicine call (practitioners and telepresenters), and ability to assess patient condition (practitioners only). We used descriptive statistics to analyze the survey responses. Kruskal-Wallis χ 2 test was used to compare satisfaction scores between professional roles. P values were 2-sided, and statistical significance was set at P < .05. Data were analyzed from November 1, 2020, to March 1, 2021, using R statistical software version 1.4.1106 (R Project for Statistical Computing).  (Table).
Among all patients, 453 patients (94.0%) reported a positive overall telemedicine experience ( Figure, A-