[The demand for emergency medical care by the prison population].
BACKGROUND
Urgent medical claim from recluse population shows some special traits due to firstly, the reclusion situation itself and the high prevalence of certain diseases in this population, as the infections ones, such as HIV infection, hepatitis B and tuberculosis. Moreover, emergency rooms constitute for this patients, a common previous admission place. Thus, a high and a complex medical care claim must be expected from this population in hospital emergency rooms.


METHODS
Consultations from ill prisoners examined in emergency room of Hospital Clinic Internal Medicine department during 1993, were checked: Age, sex, date, time of visit, serology and HIV risk factor, stage infection among positive HIV subjects, cause of complaint. age o symptomatology, number and the kind of complementary examinations done, the consulting time, the diagnosis and its link to the HIV infections, the consulting recurrence, and its relation with the initial cause, and the patient final destiny.


RESULTS
394 patients, from 598 who consulted, were visited (1.8% total consultings). The mean age was 32.4 years and 92% were men. A 68% (268 patients) realized that had HIV infection, and among these, a 37% (99 patients) were AIDS. The most frequent cause of complaint were related to respiratory, digestive, neurologic and non foci fever, which caused the higher number of admissions. The tuberculosis diagnosis was done in 39 patients (9.9%). Sixty wine patients discharged from hospital on first examination came again one or more times to the emergency room because of the same complaint. The number of complementary examinations done was 1,370 (a mean of 2.4 per visit), and were significantly higher among the HIV patients than in negative or unknown (p < 0.001). The overall admissions average was 37%, which increased to 71% among patients visited repeatedly. The HIV recluse patients required admission in the 46.3% of visits, and the HIV negative ones, in the 20.6% (p < 0.001). The duration of the visit among the patients that were discharged was 4 hours and 54 minutes.


CONCLUSIONS
Recluse population generates an important urgent medical care claim. The number of admissions among this population is elevated and higher than the respective to the general one, related to the age. This high number of consulting, the increased number of admissions and the complex assistance (high number of complementary examinations that often requires high technology, and the repetitive urgent visits, etc.), are caused, mainly by the high prevalence of HIV infections among this population.
Miret
C
C
Servicio de Medicina Interna General, Hospital Clínic i Provincial, Barcelona.
Miro
O
O
Pedrol
E
E
Gómez-Angelats
E
E
Casademont
J
J
Camp
J
J
Milla
J
J
Urbano-Márquez
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology; D015497:HIV-1 / Q000276:immunology; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006746:Hospital Bed Capacity, 500 and over; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011329:Prisoners / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology