Telemedicine implementation in Austrian correctional facilities: a qualitative interview study with prison staff

Austrian correctional facilities face persistent shortages of on-site physicians challenging the principle of equivalence of care. Consequently, the Ministry of Justice launched a telemedicine (TM) pilot to support primary care in correctional facilities without round-the-clock medical cover. The goal of this study was to evaluate TM alongside its implementation in order to investigate key stakeholders' experiences with TM and its integration into routine medical practice and to assess if and how health technologies such as TM can be used to improve quality of care in underserved facilities long-term.

We conducted a qualitative evaluation study with semistructured interviews which were analysed using thematic analysis.

Using purposive sampling across 20 correctional facilities, we interviewed a total of 48 participants (35 nurses, 3 physicians, 7 facility directors, 3 correctional officers).

TM emerged as a tool to partially mitigate the shortage of physicians. Participants viewed TM as well suited for low-risk prescribing, follow-ups, discussion of test results and administrative tasks, while emergencies and presentations requiring physical examination remained unsuitable for TM according to interviewees' reports. Nurses emerged as central operational actors who scheduled and prepared visits, mediated communication and implemented postconsultation tasks; the resulting workload was experienced as either increased (added coordination work) or reduced (fewer external transfers), depending on context. Overall, TM was valued as a complement rather than a replacement for in-person care. Perceived quality of TM depended on technical reliability, adequate space and-critically-the remote clinician being familiar with facility routines and patients.

Effective scaling should include clear clinical use criteria, stable remote clinician assignment, close collaboration with on-site staff and acknowledgement of nursing workload, while maintaining access to in-person assessment for complex or urgent cases, as well as personalised, in-person care.