Project dates: 01/01/2023 - 31/12/2023
Project dates: 01/01/2023- 31/12/2023.
Changing how prisoners access ‘over the counter’ (OTC) medications of paracetamol and ibuprofen
This project assesses the impact of a recent trial at one Queensland Correctional Centre which has changed how prisoners access paracetamol and ibuprofen, unscheduled ‘over the counter’ (OTC) medications which generally do not require a prescription. Current practice in most Australian prisons is access via the prison health centre: that is, prisoners need to have a consultation with a doctor or nurse to access paracetamol or ibuprofen.
The project: The OTC trial changed access, so a small group of prisoners may also purchase paracetamol and ibuprofen through “prisoner buy-up”. This is where, typically on a weekly basis, prisoners can buy a fixed range of consumer items (e.g., groceries, stationary, small gifts etc) up to a set monetary limit. Our project is an independent assessment of this trial, driven by one central research question: what are the benefits and challenges of changing how prisoners access unscheduled ‘over the counter’ medications of paracetamol and ibuprofen from the perspective of prisoners, health (nursing, pharmaceutical, medical) and correctional centre staff (management and operational)?
As well as surveying these key stakeholders, the project team is conducting in-person focus groups to assess the efficacy of the program, any operational challenges, learnings, and processes, designed to inform a potential state-wide roll-out of these two OTC pain medications.
The rationale for change: The public policy rationale for changing how prisoners access unscheduled ‘over the counter’ (OTC) medications is three-fold. Firstly, this change responds to international and domestic human rights obligations. The Nelson Mandela Rules require that prisoners have access to healthcare commensurate with that available in the community, while the Human Rights Act 2019 section 37(1) states ‘every person has the right to access health services without discrimination’. As adults can easily purchase and consume paracetamol and ibuprofen from supermarkets in the community, allowing access to these medications during ‘prisoner buy-up’ better aligns with the Nelson Mandela Rules and the Human Rights Act 2019.
Secondly, international best practice: prisoners in many countries across the globe access many medications, such as paracetamol and ibuprofen ‘over the counter’ (since 2003 in the United States of America, 2014 in Canada and 2015 in the United Kingdom). The argument is that: just as people in the community, prisoners should be encouraged to self-manage their health for minor ailments (including mild pain symptoms) – this promotes patient self-reliance and participation in their own health care – often termed health literacy. Thirdly, a recent local consultation led by Health Consumers Queensland noted that many prisoners ‘spoke about the difficulty in getting Panadol or Ibuprofen to deal with their pain”, especially at night and desired easier access via ‘buy-up’. Our project responds to such issues, assessing the experience of changing how prisoners access OTC pain medications.
The conceptual framework: In exploring the impact of this policy change, we are guided by Carl May’s (2007) Normalisation Process Theory. NPT helps identifies factors that promote and inhibit the routine incorporation of complex healthcare interventions into everyday practice. NPT focuses on how adoption, integration and implementation is operationalised, in four key areas: Sense-making/coherence (i.e., is the intervention easy to describe?; Do participants have a shared sense of its purpose?); Participation (i.e., do target user groups think it is a good idea?); Collective Action (i.e., is the intervention affecting the work of user groups?; how compatible is it with existing work practices; how is it impacting resources, power, and responsibility between different groups?); and Reflexive Monitoring (i.e., how are users likely to perceive the intervention once it has been in use for a while?; is it be clear what effects the intervention has had?). May’s NPT is a commonly accepted approach for exploring healthcare implementation, which supports a process of collective, self-reflective inquiry, in which stakeholders seek to understand how interventions are embedded (or not) into routine practice.
Queensland Health’s Office for Prisoner Health and Wellbeing.
- Prof Evonne Miller – QUT, Director, QUT Design Lab
- Prof Lisa Scharoun – QUT, Head, School of Design
- Prof Melissa Bull, QUT – Director, QUT Centre for Justice
- Prof Jane Phillips – QUT, Head of the School of Nursing
- Prof Lisa Nissen, UQ
- Dr Jane Hwang, UNSW
- Dr Abbe Winter, QUT.