Access to Specialty Services: Opportunities for Expansion of Telemedicine to Support Correctional Health Care in Colorado

Introduction: The United States has the largest correctional population in the world and many inmates lack access to timely health care. Studies have shown that telemedicine could improve the situation in a practical and cost-effective fashion. We aimed to evaluate currently established services as well as any potential need for expansion of telemedicine within correctional settings in Colorado. Methods: We designed a prospective survey-based pilot study using mixed methods research techniques. Results: Colorado has 50 county jails, 19 prisons, and 3 private prison facilities. Of these, 46 correctional facilities (45 jails and the state prison) were contacted. Twenty responded (19 jails and the prison) representing 43.5% response rate. Only 10% did not have on-site health care providers available at all, 31.6% were already using telemedicine for some of their needs, 52.9% were "very interested," 5.9% "somewhat interested," 17.6% "not so interested," and 23.5% were "not at all interested" in further information regarding telemedicine services. Discussion: Our study as well as current literature suggest that telemedicine could serve to fill in certain gaps of care within correctional populations, especially for over-represented conditions (i.e., chronic infectious diseases, such as HIV and hepatitis C virus, substance use disorders, or mental health disorders). Conclusions: There is enthusiasm but also certain amount of skepticism among Colorado's jail administrators with respect to the implementation, or even the cost-effectiveness potential of telemedicine. Telemedicine in these settings may require individualized approach and enough creative flexibility to allow for nimble adjustments based on the constraints and needs of individual institutions.