Improving the Experience of Care for people prescribed Medications with a risk of Dependence or withdrawal in prison: The ECMD-prisons study.

Background: Medications with a risk of dependence or withdrawal are prescribed at higher rates in prison than in the general population. Prisoners have poorer health and more complex health needs than the general population but are often excluded from healthcare research. The Office for Health Improvements and Disparities (formerly Public Health England) have raised concerns into how these medications are managed and how care is experienced by patients. Managing these medications in prison environments is significantly more challenging with inequality in access to, and quality of, healthcare in prison. Aims and objectives: This study aims to improve the experience of care for prisoners prescribed medicines with a risk of dependence or withdrawal, including benzodiazepines, z-drugs, gabapentinoids and opioids for chronic (non-cancer) pain. Working in partnership with prisoners, former prisoners and prison healthcare professionals we will: i) develop understanding of current prisoner and healthcare staff experience, ii) co-identify priorities to improve the experience and quality of care, iii) co-design and implement solutions to improve the quality and experience of care in prison. Methods: The study will use Experience Based Co-Design, a form of participatory action research designed to improve treatment and care. Working with two category B or C prisons (one male, one female), we will recruit 20 prisoners and 15 prison healthcare staff. Individual semi-structured interviews will be conducted. Interviews with prisoners will focus on key phases of the patient journey, whilst interviews with staff will focus on what is and is not working well from their perspective. The same prison healthcare staff will then work with 10 former prisoners (to reduce pressure on prison resources) to co-identify priorities for prison healthcare service improvement and to co-design solutions to improve the experience of care for prisoners. Co-designed solutions will be implemented within the participating prison sites. Timelines for delivery: This two-year study will commence in January 2026. Two work-packages will run sequentially, implementation and dissemination activities will commence in month 22 of the study and will continue beyond the current study end. Anticipated impact and dissemination: this study will contribute to improved prisoner experience of care and a reduction in the harm associated with use of medications with a risk of dependence and withdrawal. The study will provide new and much needed insights into the aspects of prison healthcare that require improvement as well as co-designed tailored solutions to improve the quality of care. These solutions will be implemented across the 15 prison estates managed by Spectrum Community Health CIC, a prison healthcare provider. A range of accessible outputs will be developed, and study findings will be widely disseminated by our partner organisations ensuring wider reach and impact. The outcomes of the study represent an important step in addressing inequality in prison healthcare.