Journal Article

Engaging Individuals Recently Released From Prison Into Primary Care: A Randomized Trial

Hong, Clemens S., Kessell, Eric, Shavit, Shira, Sanders, Ronald, Wang, Emily A., Kushel, Margot B.

2012

Overview

Objectives. Individuals released from prison have high rates of chronic conditions but minimal engagement in primary care. We compared 2 interventions designed to improve primary care engagement and reduce acute care utilization: Transitions Clinic, a primary care–based care management program with a community health worker, versus expedited primary care. Methods. We performed a randomized controlled trial from 2007 to 2009 among 200 recently released prisoners who had a chronic medical condition or were older than 50 years. We abstracted 12-month outcomes from an electronic repository available from the safety-net health care system. Main outcomes were (1) primary care utilization (2 or more visits to the assigned primary care clinic) and (2) emergency department (ED) utilization (the proportion of participants making any ED visit). Results. Both groups had similar rates of primary care utilization (37.7% vs 47.1%; P = .18). Transitions Clinic participants had lower rates of ED utilization (25.5% vs 39.2%; P = .04). Conclusions. Chronically ill patients leaving prison will engage in primary care if provided early access. The addition of a primary care–based care management program tailored for returning prisoners reduces ED utilization over expedited primary care.

• Publisher: American Public Health Association
• Subject: Acute services / Adult / Case management / Chronic Disease - therapy / Chronic illnesses / Clinical outcomes / Clinical trials / Community health workers / Community-Based Participatory Research / Education / Emergency medical care / Emergency medical services / Emergency Service, Hospital - statistics & numerical data / Emergency Service, Hospital - utilization / Emergency services / Enrollments / Female / Follow-Up Studies / Health care management / Health care policy / Health Promotion - methods / Health services utilization / Health status / Hospitalization / Hospitals / Humans / Imprisonment / Indigent care / Intervention / Male / Medical workers / Middle Aged / Online Research and Practice / Patients / Primary care / Primary Health Care - statistics & numerical data / Primary Health Care - utilization / Prison overcrowding / Prisoners / Prisons / Public health / Questionnaires / San Francisco / Training / Wages & salaries