Health problems in a city-county workhouse.

This study was part of a continuing effort to define the health profile of a city-county workhouse inmate population. To supplement data previously obtained on the health status of inmates on admission, all subsequent encounters for medical problems were recorded and analyzed. Of 491 inmates examined on admission, 312 subsequently made 1,257 visit for medical care. The rate of clinic use was two to three times higher than rates reported in national surveys. Of 1,549 problem encounters, trauma, musculoskeletal complaints, skin disorders, and diseases of the eyes, ears, nose, and throat accounted for 52.3 percent. Dental disease, trauma, and other musculoskeletal disorders comprised 66.3 percent of problems that required referral of patients to the city-county hospital. A significant relationship was seen between depression as determined by a self-rating questionnaire and numbers of visits and problem encounters, as well as several frequently encountered problems. The results of this study have implications for health services in correctional institutions with similar inmate populations. The provision of limited but onsite dental services is advisable. Athletic activities and work details should be closely supervised. Physicians and nurses should be skilled in the evaluation and management of minor trauma and other musculoskeletal disorders. Algorithms are appropriate aids in the management of common but minor medical problems. These measures and proposals are designed also to deal with the problem of overuse of clinic services. However, the measures do not diminish and, in some instances, they increase access to care for medical and dental health needs.