Abstract
BackgroundAccess to primary care is an important determinant of health, and data are sparse on primary care utilization for people who experience imprisonment. We aimed to describe primary care utilization for persons released from prison, and to compare utilization with the general population.MethodsWe linked correctional data for all persons released from provincial prison in Ontario, Canada in 2010 with health administrative data. We matched each person by age and sex with four general population controls. We compared primary care utilization rates using generalized estimating equations. We adjusted rate ratios for aggregated diagnosis groups, to explore this association independent of comorbidity. We examined the proportion of people using primary care using chi squared tests and time to first primary care visit post-release using the Kaplan-Meier method.ResultsCompared to the general population controls, the prison release group had significantly increased relative rates of primary care utilization: at 6.1 (95% CI 5.9-6.2) in prison, 3.7 (95% CI 3.6-3.8) in the week post-release and between 2.4 and 2.6 in the two years after prison release. All rate ratios remained significantly increased after adjusting for comorbidity. In the month after release, however, 66.3% of women and 75.5% of men did not access primary care.ConclusionsPrimary care utilization is high in prison and post-release for people who experience imprisonment in Ontario, Canada. Increased use is only partly explained by comorbidity. The majority of people do not access primary care in the month after prison release. Future research should identify reasons for increased use and interventions to improve care access for persons who are not accessing care post-release.
Highlights
Access to primary care is an important determinant of health, and data are sparse on primary care utilization for people who experience imprisonment
We examined the proportion of persons in the prison release group and general population controls who accessed any primary care in each time period, and we compared the proportions between groups using chi squared tests
We excluded 233 persons who had a release period of 1 day or less in 2010, 2,178 persons transferred to federal custody on release, 7 persons whose reason for release was death, and 1,267 persons whose reason for release was related to immigration, leaving 48,861 persons in the prison release group
Summary
Access to primary care is an important determinant of health, and data are sparse on primary care utilization for people who experience imprisonment. We aimed to describe primary care utilization for persons released from prison, and to compare utilization with the general population. Given the increased morbidity and mortality experienced by this population [3], primary care in prison and Studies from several countries have found increased primary care utilization for people while in prison and Kouyoumdjian et al BMC Health Services Research (2018) 18:845 after release [5, 7,8,9,10,11,12,13]. Studies in the USA have identified relatively low use of primary care in prison and on release [14,15,16,17]. We lack information on the ways in which factors such as comorbidity may contribute to increased health care utilization
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