Table 1 Summary of included studies
First  author and year of publication | Country | Implementation aim | Study population | Study design | Implementation intervention | Outcomes | Author conclusions |
|---|---|---|---|---|---|---|---|
Arif, T. 2018 | UK | To improve the uptake of blood borne virus screening and vaccination | 6452 adult males in one category B prison | Uncontrolled before and after | Promotional campaign with printed materials and education for incarcerated persons Rapid hepatitis vaccination schedule and testing offered to all current and new incarcerated persons | Compliance to guidelines Vaccination and screening uptake | Increased rate of hepatitis B and hepatitis C vaccinations offered. Prison guard understaffing judged to affect uptake of services. |
Beyda, R. M. 2018 | USA | To improve contraception counselling and initiation in young adolescent women | 306 juvenile female detainees in pre-adjudicational centre | Uncontrolled before and after | Modified intake form to collect information on contraception Staff training on contraception counselling Printed materials for patients | Proportion of women initiated on contraception Proportion of women continuing contraception use | Higher proportions of women counselled, initiated and continuing to use contraception. |
France | To determine psychiatrists and pharmacist’s adherence to prescribing guidelines | 1249 adult males in one prison | Uncontrolled before and after | Collaborative guideline development between psychiatrists and pharmacists | Mean daily dose of benzodiazepine prescribed | Sustained reduction in dosage over the 15 years, although no reductions in those already taking smaller doses. Reduced number of patients on benzodiazepines. Introduction of non-pharmacological treatment during follow up may have contributed to dose reductions. | |
Elwood Martin, R. 2004 | Canada | To determine impact of implementation of a nurse-led cervical screening clinic | 484 adult females in one correctional centre | Uncontrolled before and after | Development of a nurse-led cervical screening clinic providing one-to-one education, screening and discussion around treatment | Proportion of women screened and tested | No change in proportion of women screened after intervention. Women over age of 30 years were less likely to have a smear whilst those with lower education status and longer sentences were more likely to have a smear. |
Emerson, A. M. 2020 | USA | To describe the 1-year postintervention rates of sexual health education on cervical health literacy and screening | 133 adult females in two prisons | Mixed methods study, including uncontrolled before and after | Implementation of sexual health empowerment protocol with group education sessions | Cervical cancer screening knowledge, beliefs, self-efficacy and confidence Cervical cancer screening history and health history | Increased number of women with up-to-date screening. Higher cervical health literacy scores. |
Finnie, A. J. 2018 | UK | To increase referrals to health trainers from clinicians and screening clinics | Unspecified number of males in one category C prison | Uncontrolled before and after | Alerts created on electronic health record for patients eligible and due health checks Referral tool updates with further alert tools Employment of local champions | Number of referrals to health trainers | Increased referrals, with consistent improvement over each intervention cycle. Operational disruption appeared to reduce referrals for three months. |
Francis-Graham, S. 2020 | UK | To determine effectiveness of a pathway of care for hepatitis C screening and treatment in prison | 12964 adult males in one category B prison | Uncontrolled before and after | Implementation of a hepatitis C testing pathway Introduction of referrals direct to multidisciplinary team | Proportion of testing offered and accepted Proportion of referrals to multidisciplinary team | Difficulty engaging prison staff in testing pathway due to staffing pressures. Increased testing following adaptation of pathway, which remained below national targets. |
Lee, T. 2016 | USA | To assess the impact of implementing psychiatric practice guidelines on medication costs and youth aggression in a juvenile justice facility | Three juvenile justice facilities | Controlled interrupted time series analysis | Implementation of psychiatric practice guidelines | Medication cost by proxy of medication use Mental health acuity scores Aggression-related incident rates | Reduction in psychiatric medication costs over 10 years at the intervention facility compared to increases at control facilities. Reduced aggression-related incidents reported. |
Lin, C. H. 2019 | USA | To improve diabetes management of detained persons through a pharmacist-led diabetes clinic | 240 adult males from two jail facilities | Uncontrolled before and after | Implementation of a pharmacist-led diabetes clinic | Glycaemic control (HbA1c) Proportion prescribed appropriate statin | Reduced mean HbA1c levels, especially in those with earlier higher HbA1c levels, but increase in those with earlier better control. Increased appropriate statin prescribing. |
Meine, K. 2018 | USA | To improve perinatal depression screening and management | 101 adult females housed at two jail facilities. | Mixed methods study, including uncontrolled before and after | Four improvement cycles including staff engagement, patient engagement, implementation of a perinatal depression screening tool, and referral and treatment tools. | Adherence to protocol Patient semi-structured interviews Screening proportions | Increased proportion of women screened and treated for perinatal depression, although unable to attribute this to any intervention component over the four cycles. |
Morey, S. 2019 | UK | To improve blood borne virus testing and treatment rates | 4280 adult males in two prisons | Uncontrolled before and after | Development of testing pathway offering universal opt-out dry blood spot testing (DBST) Telemedicine (consultant-led) and in-reach nurse-led clinic | Proportion of DBST offered and undertaken Proportion of positives and referrals to treatment team | Increased offers and acceptance of DBST, sustained over six months. Improved attendance rates at telemedicine clinic compared to face-to-face clinics. |
O’Toole, S. 2018 | Ireland | To explore efficacy of an exercise referral scheme for promoting mental health | 30 adult males in one prison | Mixed methods study, including uncontrolled before and after | Exercise referral scheme | Depression and anxiety scale, anger scale and self-esteem symptom scale Patient semi-structured interviews | Improved symptoms scores for anxiety, depression, stress, anger and self-esteem |
USA | Investigate if a model of HIV care would improve quality of care | 14 clusters of matched prisons | Cluster randomised controlled trial | Introduced a local change team with a QI protocol Staff training on protocol | Screening uptake for HIV Proportion of positive HIV cases Patient knowledge surveys Protocol adherence | Improvement in patient knowledge scores and proportion of HIV screening uptake. Reported adequate adherence to the structural components of the improvement protocol in 12 sites. | |
Reeves, R. 2012 | USA | To reduce benzodiazepine and quetiapine prescribing for insomnia | Prisons served by psychiatrists from one state | Uncontrolled before and after | Introduction of prescribing guideline Staff training Allowed for psychiatrists to anonymously compare their prescribing to others’ | Proportion of patients prescribed benzodiazepines and quetiapine | Reduced benzodiazepine and quetiapine prescribing. |
Toledanes, Y. D. 2021 | USA | To evaluate the impact of protocols to improve identification and management of asthma in juvenile detainees | 764 juvenile detainees at two facilities | Uncontrolled before and after | Implementation of asthma diagnosis protocol Staff training Printed materials to staff | Prevalence of asthma Proportion of inhaler use Staff adherence to protocol | Reduced recorded prevalence of asthma. Reduction in inhaler costs. |