Characterization of pharmacy services in Portuguese prisons: a national survey Liliana Alexandra Monteiro Guerra and Paula Fac¸anha da Cruz Fresco

Liliana Alexandra Monteiro Guerra is based at Pharmacy Department, Special Prison Santa Cruz do Bispo, Porto, Portugal. Paula Fac¸anha da Cruz Fresco is Associate Professor, based at Department of Drug Sciences, Faculty of Phamacy, University of Porto, Porto, Portugal.

Abstract Purpose – The primary purpose of this paper is to collect reliable information to characterize the pharmacy services in Portuguese prisons. The secondary purpose is to develop a set of suggestions for improving these services and, therefore, improve the health services provided to the inmate population. Design/methodology/approach – A three pages survey was developed that included questions covering the characterization of prison health teams, pharmacy services and pharmacy activities. This survey was sent to all Portuguese prisons, with capacity higher than 50 prisoners. The response rate was of 87.5 per cent. Findings – It was found that only 6.1 per cent of prisons had pharmacists and that in 63 per cent the guards still participated in pharmacy activities. There were not Pharmacy and Therapeutics Committees in 94 per cent of prisons and 94.4 per cent did not present adequate storage conditions for drugs. Only 51.7 per cent of prisons had computers in the pharmacy and only 3.4 per cent had access to the internet. This study found that there is a gap between public and prison pharmacy services, since most prison pharmacies in Portugal are solely locals of storage and distribution of drugs, with no effective management nor promotion of drug rational use. Originality/value – This paper is the first study about pharmacy services in Portuguese prisons. The information collected could be very useful to improve the Portuguese prison pharmacy services provided to prisoners. Keywords Correctional health care, Prison staff Paper type Research paper

Introduction According to the World Health Organization (WHO), at any given time, over two million people are incarcerated in Prison Establishments (PEs) in Europe (World Health Organization, 2011a, b). In Portugal, the prison population is the highest in Western Europe, as outlined in the Portuguese National Health Plan 2004-2010 (General Directorate of Health, 2004). Several studies report that, globally, rates of tuberculosis, HIV and hepatitis are much higher in prisons, comparatively to the general population as are the prevalence of mental health problems and substance abuse (Condon et al., 2007; Taylor et al., 2010; Hostick et al., 2004). Imprisonment may thus represent a powerful and unique opportunity to address health needs of prisoners and reduce inequities in health, as the prisoners, for a certain period of time, have access to prison health services (World Health Organization (WHO), 2007).

The authors are grateful to Prof Joaquim Monteiro, for the fruitful discussions and suggestions.

DOI 10.1108/IJPH-04-2013-0016

Several international documents address the issue of prison health. All of these refer to the equivalence of prisoners’ rights and acknowledge the gap that exists between public and prison health (World Health Organization, 2003, 2004, 2011a, 2011b; Northern Dimension Partnership on Health and Social Well-Being, 2009). Further, all these documents recognize the existence of health inequities in prisons and agree that protecting the health of prisoners also protects the health of the general population.

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As stated in the Decree-Law No. 265/79 (1979) of 1 August, Article 95, one of the health services that must be provided to Portuguese inmates is pharmacy services: “Every institution should have, according to its needs, and as far as possible [y] pharmaceutical services to meet the essential requirements to prevent and treat the health of inmates”. Since the publication of this Decree, few documents discuss the issue of health in Portuguese prisons and even fewer consider the issue of pharmacy services. The few documents that do consider health issues in Portuguese prisons include the reports of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), which conducts periodic visits to various European prisons. The first CPT report on Portugal, stated that drugs with expired dates were found and also acknowledged the inadequacy of health care services provided to inmates and the involvement of prison guards in providing health care, a fact considered unacceptable by the committee (European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), 1993, 1996, 2009). In 1996, the Ombudsman Report (OR), which considered the reality of Portuguese prison pharmacies, their organization and operations, became available. This OR concluded that, although improvements had been made, much remained to be done in respect of the health services provided in Portuguese PEs. In most PEs, there was no pharmacy; if a pharmacy did exist, it simply comprised lockers where drugs were stored (OR, 1996). In some PEs, inmates gave assistance in clinical settings, particularly in drug administration, despite the United Nations Standard Minimum Rules and the European Prison Rules, which recommend that “[y] no inmate may play, in the prison services, any activity involving power” (OR, 1996). In almost all PEs, medication distribution was done in the presence of guards or nurses, in individual doses. However, medication preparation or even medication interruption were frequently carried out by guards or other non-medical staff (OR, 1996). In 1999, another OR was published, which illustrated the diversity of local storage of medication: lockers in the lobby, medical facilities, guards bar and the administrative sector of the guards (Ombudsman Report (OR), 1999). Moreover, the security of the pharmacy departments was also considered a problem as a significant number of PEs provided pharmacy access to guards and some prisoners. The OR recommended that this situation should be reviewed (OR, 1999). Similar situations have occurred, in the past, at prison pharmacies in other European countries, namely England (Reed and Lyne, 2007; Department of Health of England (DHE), 2003), Scotland (McNulty et al., 2001) and France (Cabelguenne, 2007). However, these countries have subsequently introduced reference documents such as “Health Care Standards in Scottish Prison Service” (Scotland) (McNulty et al., 2001), “Act of 18 January 1994” (France) (Cabelguenne, 2007), “Pharmacy Services for Prisoners” (England) (DHE, 2003), which have gone some way to improving the prison pharmacy services in these countries. In 2003, a further OR (Ombudsman Report (OR), 2003), still notes instances of inmates assisting clinical services, particularly the preparation and distribution of medication, although improvements in the security of pharmacies had occurred. The latest report of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT, 2009), continues to point out the inadequate participation of guards in the distribution of drugs in Portuguese prisons. Although national legislation refers to the basic principle of equivalence in health care (Law No. 48/90), the health care provided in Portuguese prisons has been, for many, inadequate. The lack of information and studies on the current reality of prison pharmacy services in Portugal is evident. Moreover, the General Direction of Prison Services stated, in the authorization given to this study, that “[y] this work is considered of interest to the services because there are no published studies on this matter”. The primary aim of this study was, therefore, to collect reliable information on the characteristics of pharmacy services in Portuguese prisons and characterize the activities and services provided by prison pharmacies in Portugal. The secondary aim was to develop a set of suggestions to improve these services and, by implication, improve the health services provided to the inmate population.

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Methodology Survey design To meet the aims of this study, a three-page survey was developed that included questions relating to the characterization of prison health teams, pharmacy services and pharmacy activities in PEs. The survey was based on three reference manuals: the “Manual of Hospital Pharmacy” from the Portuguese Ministry of Health (PMH, 2005), the guide “Pharmacy Services for Prisoners”, from the DHE (2003) and the “ASHP Guidelines on Pharmaceutical Services in Correctional Facilities”, from the American Society of Health-System Pharmacists (ASHP, 1995). The questions were closed, simple or of multiple choice. The purpose of the questionnaire was clearly presented. Sample selection From the Portuguese list of PEs (General Directorate for Prisons, 2008), a list of 40 PEs was obtained, using the inclusion criterion: PEs with a holding capacity greater than 50 prisoners. All PEs from this list received the survey. The necessary permission for conducting the study was obtained from the General Direction of Portuguese Prison Services. Survey mailing Survey procedures included making telephone contact to notify potential recipients that a questionnaire would be sent and to explain its purpose. Messages were also sent, via electronic mail and fax, to the PEs directors and/or PEs directors of PEs pharmacy departments, with a copy of the authorization of the General Direction of Portuguese Prison Services (where the participation of all PEs in the study was requested). Data analysis Descriptive statistics were computed for variables in the questionnaire, using SPSS version 18.0.

Results and discussion The 40 PEs sample obtained with our inclusion criterion are representative of the country as a whole either in type of PE, geographic distribution or sex of inmates (see Table I). Of the 40 surveys delivered, a total of 35 were returned, yielding a response rate of 87.5 per cent. We found that improvements had taken place in prison health human resources, as the survey returns indicated that all the PEs had doctors (100 per cent) and almost all had nurses

Table I Sample characterization PEs who responded the survey (n ¼ 35) Geographic location of PEs North Centre South Islands Type of PE a Central Regional Special Prisioners sex Male Female

National data (n ¼ 50)

10 (77%) 11 (100%) 13 (59%) 1 (25%)

13 11 22 4

14 (93%) 18 (60%) 3 (60%)

15 30 5

5,692 (55%) 683 (100%)

10,325 683

Notes: aType of PEs: central (for the fulfillment of measures involving deprivation of liberty exceeding six months); regional (for the fulfillment of measures involving deprivation of liberty until six months); special (for the internment of prisoners who are in need of specific treatment, including detention centers for young adults, women, prison hospitals and psychiatric hospitals)

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(97 per cent). Nevertheless, there was a clear shortage of skilled human resources in pharmacy departments, as only 6 per cent of PEs had pharmacists. This indicates that the situation in Portugal differs from other countries: in Scotland and Ireland, for example, pharmacists are fully integrated in health prison teams (Irish Prison Service, 2011; McNulty et al., 2001). In Spain, the provision of pharmaceutical care in prisons is under the supervision and control of a pharmacist (Spain’s Interior Ministry – General Directorate of Penitentiary Institutions, 2007). In the USA, as well as in the UK and France, pharmacists are part of the clinical team of PEs (Federal Bureau of Prisons, 2005; HM Prison Service, 2005; Harcouet and Hazebroucq, 2000). The survey returns indicated that only 20 per cent of PEs clinical services operated 24 hours/day (either on-site clinical staff or on-call clinical staff), despite the WHO recommendation, in the guide “Health in Prisons” that “all prisons should have access to health services at all hours” (WHO, 2007). The data also indicated that in the majority of PEs, nurses were responsible for the prison pharmacy while 17.1 per cent of PEs had non-medical professionals, namely guards and administrative personnel, responsible. This is despite the national and international pharmacy guides, which state that the provision and supply of medicines and controlled drugs for prisoners must be under the profession and legal supervision of a registered pharmacist (Freitas, 2011; Decree-Law No. 307/2007, 2007; ASHP, 1995). Further, qualified professionals (pharmacists) were responsible for the pharmacy department in just 6 per cent of PEs. Similarly, in 12.1 per cent of PEs other professionals, including guards, non-qualified assistants and administrative personnel were working in the pharmacy. The existence of non-medical professionals working in prison pharmacies has been reproved several times, both by the CPTs (European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), 1993, 1996, 2000, 2003, 2009) and ORs (OR, 1996, 1999, 2003). The latter repeatedly stated that: “The issues surrounding the recruitment of medical and paramedical staff for the prison system are probably the most delicate problems facing the prison system in the area of health care for prisoners” (OR, 2003). Pharmacy security is also a cause for concern as in 60 per cent of PEs, non-medical staff had access to the pharmacy keys. However, access to prison pharmacies should only be provided to medical and paramedical staff, as recommended in the ORs (OR, 1996, 1999, 2003). Analysis of the data also indicated that only 54 per cent of PEs used Drugs Formularies and 69 per cent do not use non-formulary medication justifications. In England and the USA, many prisons use Drug Formularies (Federal Bureau of Prisons, 2005; DHE, 2003). The existence of Formularies and non-formulary drugs justifications is essential to the process of streamlining prescription in prisons (Pharmacy and Therapeutics Committee of the Regional Health Service, 2005), choosing drugs that meet both the therapeutic needs of prisoners and economic considerations (PMH, 2005). In 94 per cent of the studied PEs, a Pharmacy and Therapeutics Committee (PTC) does not exist. Nevertheless, the existence of these committees is recommended, both in USA (Federal Bureau of Prisons, 2005) and in England, where 59 per cent of PEs have PTC (DHE, 2003). In Portugal, the Decree-Law No. 188/2003 (2003), establishes that the PTC represents an important organ of technical support to hospital management, contributing to the development of medication policies based on accuracy and security information, safeguarding budget sustainability. Regarding reception of drugs, all PEs made the drugs qualitative and quantitative conference, but most did not register the drug batch (89 per cent), the expiration dates (66 per cent) and the drugs total price (91 per cent). However, all these procedures should be carried out in all PEs (PMH, 2005). The environmental conditions of medication storage places, including temperature and humidity, are clearly established for each medicine (Summary of Product Characteristics). Nevertheless, most PEs do not have air conditioning (97 per cent) and do not monitor/register temperature and humidity levels.

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All PEs monitored drugs expiry dates, despite only 3 per cent of PEs controlling drugs by using ICT. This is related to the lack of informatics systems in prison pharmacies generally, as described later. Narcotic and psychotropic drugs are subject to specific legislation (Decree-Law No. 15/93, 1993; Law No. 45/96 of 3 September; Regulatory Decree-Law No. 61/94; Ordinance No. 981/98). This legislation refers in particular to storage conditions and control requirements. However, 36 per cent of PEs does not obey this legislation. Only 62 per cent of PEs double-checked the medication before dispensing it to inmates. This procedure allows the detection and correction of medication errors and should be instituted in all PEs, as recommended by the ASHP (ASHP, 1995). The repackaging and relabeling of drugs enables the pharmacy to have medication in the prescribed doses, reduces medication errors and contributes to the economic use of resources (PMH, 2005). Despite the benefits of this process, only a few PEs performed repackaging and relabeling. Given the large amount of drugs in use in PEs, the provision of drug information to professionals and patients, is increasingly important, as it contributes to the rational use of drugs (PMH, 2005). However, in 75 per cent of PEs, drug information was not given. All health professionals are obliged to submit information on adverse reactions occurring from the use of drugs: this contributes to the continuous monitoring of drug safety (as part of the structure of the National Pharmacovigilance System) (PMH, 2005). However, only 16 per cent of PEs indicated that they carried out pharmacovigilance activities. Regarding drug acquisition in PEs, 83 per cent of PEs purchased all, or almost all, medicines from community pharmacies. In Spain, France and USA the drugs supplier to prison pharmacies is the pharmaceutical industry (Spain’s Interior Ministry – General Directorate of Penitentiary Institutions, 2007; Federal Bureau of Prisons, 2005; Harcouet and Hazebroucq, 2000). This is also the case with hospitals in Portugal (Pharmaceutical Health Information System, 2010). In terms of drug distribution, 63 per cent of PEs used the unit dose system. In the USA this is the distribution system recommended (ASHP, 1995). However, in England, 90 per cent of PEs use the in-possession system (DHE, 2003). The system of unit dose (also used in hospitals) seems the most appropriate for prisons, because it is safer for the patient, reduces traffic, guarantees the taking of the drug and the treatment of prisoner, reduces the incidence of medication errors, makes effective use of the resources available and is economically more efficient for the institution (PMH, 2005). Drugs preparation at 18 per cent of PEs and distribution at 56 per cent of PEs, to inmates was still performed by non-medical professionals, such as guards. The guards participation in pharmacy activities in the majority of PEs (62.9 per cent) (Figure 1), run contrary to the OR recommendation: “It is recommended that the preparation of medication to inmates to be entrusted exclusively to the medical or paramedical staff and to prevent the intervention of nonmedical staff in the process” (OR, 1996). Informatics and related equipment were lacking at prison pharmacies: only 51.7 per cent of PEs had computers in the pharmacy and only 3.4 per cent had access to the internet. This equipment is essential. Indeed, the DHE (2003) considers that the introduction of an informatics system that offers the same level of information, support and supply of drugs, similar to that available on the National Health Service is an urgent priority. Moreover, responses received indicated that 80.6 per cent of PEs did not have informatics systems for pharmacy management.

Conclusions Despite the efforts made in recent years to improve health care services provided to prisoners, pharmacy services in the majority of PEs are not equivalent to those provided in the community or to those provided in international prisons. Portuguese pharmacy services in prisons do not comply with national and international legislation and recommendations. Currently, most of

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Drug Reception

Drug Selection

Figure 1 Characterization of pharmacy services activities in Prison Establishments

0%

10%

PEs using Formulary to prescribe drugs Existence of justification form for non-formulary drugs

6%

Registration of the drug batch

11%

54%

No

97%

0%

100%

97%

97% 14%

3% 86%

Existence of a safe or a locked place to store drugs

Drug Distribution

Yes

46%

3%

64%

Double confirmation of the medication before administration

36%

62% 13%

38% 87%

18%

82%

26%

Individual control of Narcotic and Psychotropic drugs

Realization of pharmacovigilance

100%

66%

Daily record of humidity

Realization of medicine information

90%

91%

9%

Daily registration of the environment temperature

Realization of drugs labeling

80%

89% 34%

3%

Realization of drugs repackaging

70%

69%

Drugs storage with air-conditioning

Existence of a pharmacy logistic informatic system

60%

94%

Registration of the drug expiry date

Daily registration of the refrigerator temperature

Other activities

50%

46%

Realization of expiry dates monitoring

Guards

40%

31%

Drugs storage at a suitable location

Drug Storage

30%

54%

Existence of a Pharmacy and Therapeutics Committee

Registration of the drug total price

20%

74% 64%

36%

25%

75% 84%

16%

Intervention of the guards in the Pharmacy and medication

63%

37%

Note: Data presented are calculated as number of PEs with the characteristic over total studied PEs (n=35 PEs)

these pharmacies are solely places of storage and distribution of drugs, with no effective management or promotion of rational drug use.

Ten suggestions to improve the prison pharmacy services provided to Portuguese inmates Following our analysis of responses to the survey, we formulated the following suggestions to help improve the Portuguese prison pharmacies services:

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S1: grant equality, to all citizens, in the access and provision of health care services, including pharmacy services;



S2: provide qualified health human resources in sufficient numbers to inmates, including doctors, nurses, pharmacists and pharmacy technicians;



S3: limit pharmacy access to health professionals;



S4: ensure the proper storage of drugs in prisons;



S5: use the unit dose system for medication distribution to inmates;



S6: create a prison drugs information centre and promote the participation of all health professionals in pharmacovigilance;

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S7: provide all prison pharmacies with support equipment (computer, printer, fax, phone, internet, manuals, etc.);



S8: provide all prison pharmacies with an informatics system for clinical and pharmaceutical management;



S9: promote studies about health services in prisons, namely the drugs acquisition process; and



S10: create a Portuguese Pharmacy Prison Guide.

Ethical approval The General Direction of Prison Services approved this work.

References American Society of Health-System Pharmacists (ASHP) (1995), “ASHP guidelines on pharmaceutical services in correctional facilities”, American Journal Health-System Pharmacy, Vol. 52 No. 16, pp. 1810-3. Cabelguenne, D. (2007), “Clinical pharmacy and professional practices assessment: example of the medical and pharmaceutical staffs of Lyons Prisons”, Journal de Pharmacie Clinique, Vol. 26 No. 3, pp. 158-65. Condon, L., Harris, F. and Hek, G. (2007), “Health needs of prisoners in England and Wales: the implications for prison healthcare of gender, age and ethnicity”, Health & Social Care in the Community, Vol. 15 No. 1, pp. 56-66. Decree-Law No. 265/79 (1979), “Reestrutura os servic¸os que teˆm a seu cargo as medidas privativas de liberdade”, Dia´rio da Repu´blica I-A Series No. 176, 1 August, pp. 1770 (5)-(36). Decree-Law No. 15/93 (1993), “Regime jurı´dico do tra´fico e consumo de estupefacientes e psicotro´picos”, Dia´rio da Repu´blica I-A Series No. 18, 22 January, pp. 234-252. ~o do Artigo 9 e 11: Law No. 27/2002 ‘Regime jurı´dico da Decree-Law No. 188/2003 (2003), ‘Regulamentac¸a ~o hospitalar’”, Dia´rio da Repu´blica I-A Series No. 191, 20 August, pp. 5219-5230. gesta Decree-Law No. 307/2007 (2007), ‘Regime jurı´dico das farma´cias de oficina”, Dia´rio da Repu´blica I-A Series No. 168, 31 August, pp. 6083-6091. Department of Health of England (DHE) (2003), “A pharmacy service for prisoners”, available at: www.dh.gov.uk/ prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4065707.pdf (accessed 23 November 2010). European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) (1993), “Report to the Portuguese Government on the visit to Portugal carried out by the CPT from 19 to 27 January 1992”, Council of Europe, Strasburg. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) (1996), “Report to the Portuguese Government on the visit to Portugal carried out by the CPT from 14 to 26 May 1995”, Council of Europe, Strasburg. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) (2000), “Report to the Portuguese Government on the visit to Portugal carried out by the CPT, from 19 to 30 April 1999”, Council of Europe, Strasburg. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) (2003), “Report to the Portuguese Government on the visit to Portugal carried out by the CPT, from 17 to 20 December 2002”, Council of Europe, Strasburg. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) (2009), “Report to the Portuguese Government on the visit to Portugal carried out by the CPT, from 14 to 25 January 2008”, Council of Europe, Strasburg. Federal Bureau of Prisons (2005), “Audit of the Federal Bureau of Prisons pharmacy services”, available at: www.justice.gov/oig/reports/BOP/a0603/final.pdf (accessed 12 December 2010). Freitas, O. (2011), “Farma´cia Hospitalar”, available at: www.ordemfarmaceuticos.pt/scid/ofWebInst_09/ defaultCategoryViewOne.asp?categoryId¼1910 (accessed 12 January 2011).

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VOL. 9 NO. 4 2013 INTERNATIONAL JOURNAL OF PRISONER HEALTH PAGE 193

General Directorate of Health (2004), Plano Nacional de Sau´de 2004-2010, Portuguese Ministry of Health, Lisbon. General Directorate for Prisons (2008), “Relato´rio de Actividades”, available at: www.dgsp.mj.pt/backoffice/ Documentos/DocumentosSite/RelAct_08/Relafinal_Vol-I.pdf (accessed 22 March 2011). Harcouet, L. and Hazebroucq, G. (2000), “Particularite´s de l’exercice pharmaceutique en prison: experience de la pharmacie de l’Unite´ de consultations et soins ambulatoires (UCSA) de la maison d’arreˆte Paris La-Sante´”, Journal de Pharmacie Clinique, Vol. 19 No. 2, pp. 149-56. HM Prison Service (2005), Guidance for the Introduction of Pharmacy Assistants, Recruitment of Pharmacy Assistances in Prison Service Health Care Centres (Number 7/2005, 28/05/05), HM Prison Service, London. Hostick, T., Stimpson, A. and Watson, R. (2004), “Prison health care: a review of the literature”, International Journal of Nursing Studies, Vol. 41 No. 2, pp. 119-28. Irish Prison Service (2011), “Prisoner healthcare”, available at: www.irishprisons.ie/care_and_rehabilitationprisoner_healthcare.htm (accessed 4 March 2011). Law No. 45/96. “Altera o decreto-lei no. 15/93, de 22 de Janeiro: Regime jurı´dico do tra´fico e consumo e estupefacientes”, Dia´rio da Repu´blica I-A Series No. 204, 3 September, pp. 2899-2901. Law No. 48/90. “Lei de Bases da Sau´de”, Dia´rio da Repu´blica I-A Series No. 165, 24 August, pp. 3452-3459. McNulty, H., Braddick, L., Watt, C., Shearin, P. and Mitchell, A. (2001), “Developing clinical pharmacy services to prisoners in Scotland”, International Journal of Pharmacy Practice, Vol. 9 No. S1, pp. 51-8. Northern Dimension Partnership on Health and Social Well-Being (2009), “Declaration on principles of cooperation between prison health and public health services and development of a safer society”, available at: www.ndphs.org///documents/1909/NDPHS_Declaration_on_Prison_Health.pdf (accessed 17 February 2011). Ombudsman Report (OR) (1996), Relato´rio sobre o Sistema Prisional, Portuguese Ministry of Justice, Lisbon. Ombudsman Report (OR) (1999), As Nossas Priso˜es II, Relato´rio Especial do Provedor da Justic¸a a` Assembleia da Repu´blica, Portuguese Ministry of Justice, Lisbon. Ombudsman Report (OR) (2003), As nossas Priso˜es, Relato´rio sobre o Sistema Prisional, Portuguese Ministry of Justice, Lisbon. ~o das medidas de controlo de estupefacientes e psicotro´picos”, Dia´rio da Ordinance No. 981/98. “Execuc¸a Repu´blica II Series, No. 216, 8 June, pp. 6479-6480. Pharmaceutical Health Information System (2010), “PHIS hospital pharma report 2010”, available at: http:// phis.goeg.at/downloads/hospitalPharma/PHIS_Hospital%20Pharma_Report.pdf (accessed 15 November 2011). Pharmacy and Therapeutics Committee of the Regional Health Service (2005), “Formula´rio de Medicamentos”, available at: www.srsdocs.com/parcerias/medform1/2005/index.htm (accessed 25 January 2011). Portuguese Ministry of Health (PMH) (2005), “Manual de Farma´cia Hospitalar”, available at: www. infarmed.pt/portal/page/portal/INFARMED/PUBLICACOES/TEMATICOS/MANUAL_FARMACIA_HOSPITALAR/ manual.pdf (accessed 22 November 2010). Reed, J. and Lyne, M. (2007), “The quality of health care in prison: results of a year’s programme of semistructured inspections”, BMJ, Vol. 315 No. 7120, pp. 1420-4. Regulatory Decree No. 61/94. “Regulamenta o Decreto-Lei No. 15/93, de 22 de Janeiro”, Dia´rio da Repu´blica I-A Series No. 236, 12 October, pp. 6183-5198. Spain’s Interior Ministry – General Directorate of Penitentiary Institutions (2007), “Procurement, supply and custody of pharmaceuticals – instruction 16/2007”, available at: www.csi-csif.es/prisiones/Article505.html (accessed 4 March 2011). Taylor, P.J., Walker, J., Dunn, E., Kissell, A., Williams, A. and Amos, T. (2010), “Improving mental state in early imprisonment”, Criminal Behaviour and Mental Health, Vol. 20 No. 3, pp. 215-31.

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World Health Organization (2003), “Declaration prison health as part of public health”, available at: www.euro.who.int/__data/assets/pdf_file/0007/98971/E94242.pdf (accessed 25 January 2011). World Health Organization (2004), “Breaking the barriers – partnership to fight HIV/AIDS in Europe and Central Asia”, available at: www.who.int/dg/lee/speeches/2004/dublin_breakingthebarriers/en/index.html (accessed 25 January 2011). World Health Organization (WHO) (2007), “Health in prisons – a WHO guide to the essentials in prison”, available at: www.euro.who.int/__data/assets/pdf_file/0009/99018/E90174.pdf (accessed 10 January 2011). World Health Organization (2011a), “Prisons and health, 2011”, available at: www.euro.who.int/en/what-wedo/health-topics/health-determinants/prisons-and-health (accessed 22 February 2011). World Health Organization (2011b), “The Madrid recommendation: health protection in prisons as an essential part of public health”, available at: www.unodc.org/documents/hiv-aids/publications/ The_madrid_recommendation.pdf (accessed 2 March 2011).

Corresponding author Professor Paula Fac¸anha da Cruz Fresco can be contacted at: [email protected]

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Characterization of pharmacy services in Portuguese prisons: a national survey.

The primary purpose of this paper is to collect reliable information to characterize the pharmacy services in Portuguese prisons. The secondary purpos...
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