Transitions Clinic Network: Challenges And Lessons In Primary Care For People Released From Prison

Shavit, Shira; Aminawung, Jenerius A.; Birnbaum, Nathan; Greenberg, Scott; Berthold, Timothy; Fishman, Amie; Busch, Susan H.; Wang, Emily A.

doi:10.1377/hlthaff.2017.0089

Cited by 93 publications

(95 citation statements)

References 21 publications

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“…All new patients at TCN sites seen between May 2013 and February 2015 were screened for inclusion in the cohort study. Referrals of recently released individuals with chronic conditions came from three main sources: correctional agencies—specifically, prisons and parole and probation offices; community agencies, such as social service agencies and community-based organizations; and traditional sources such as other clinicians or self-referral from patients [29]. Inclusion criteria were: (1) recent release from prison (within 6 months); (2) presence of at least one chronic health condition warranting primary medical care, including SUD as a chronic health condition, or age equal to or greater than 50 years old; (3) ability to provide informed consent in English or Spanish; and (4) a plan to live in the area near the TCN program site for the duration of the study.…”

Section: Methodsmentioning

confidence: 99%

Illicit substance use after release from prison among formerly incarcerated primary care patients: a cross-sectional study

Chamberlain

Nyamu²,

Aminawung

et al. 2019

Addict Sci Clin Pract

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Background More than 80% of people in jail or prison report having used illicit substances in their lifetimes. After release from incarceration, resumption of substance use carries risks, including parole revocation, exacerbation of mental health conditions, transmission of infectious diseases, and drug overdose. Methods This cross-sectional study used baseline data from the Transitions Clinic Network (TCN, www.transitionsclinic.org ), a multi-site prospective longitudinal cohort study of post-incarceration medical care. We investigated substance use among adults, with at least one chronic health condition or age ≥ 50 years, who had been recently released from incarceration and initiated care at a TCN site. Our primary outcome was any self-reported illicit substance use (heroin or other opioids, cocaine, cannabis, amphetamines, hallucinogens, MDMA, or illicit use of prescription medications) following release from incarceration. Alcohol use post-release was a secondary outcome. Using multivariable logistic regression, we also explored factors associated with illicit substance use. Results Among 751 participants, median age was 47; participants were mostly male (85%), non-white (47% black, 30% Hispanic), and on parole (80%). The proportion of participants reporting any illicit substance use and any alcohol use soon after release from incarceration was 18% and 23%, respectively. In multivariable regression, variables significantly associated with post-release illicit substance use were male gender (aOR = 3.91, 95% CI: 1.73–8.81), housing with friends or family (aOR = 3.33, 95% CI: 1.20–9.28), years incarcerated during latest prison term (aOR = 0.93, 95% CI: 0.89–0.98), weeks elapsed before engagement with TCN (aOR = 1.07, 95% CI: 1.03–1.10), being on parole (aOR = 0.58, 95% CI: 0.34–0.99), and having a drug use disorder (aOR = 2.27, 95% CI: 1.40–3.68). Conclusions Among individuals seeking medical care after release from incarceration, self-reported substance use was lower than previously reported estimates of post-incarceration substance use. Known risk factors, such as male gender and having a drug use disorder, were associated with illicit substance use, as were novel risk factors, such as less supervised housing. Though illicit substance use post-incarceration can carry severe consequences, treatment and surveillance interventions should be targeted toward individuals with greatest risk.

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Section: Methodsmentioning

confidence: 99%

Illicit substance use after release from prison among formerly incarcerated primary care patients: a cross-sectional study

Chamberlain

Nyamu²,

Aminawung

et al. 2019

Addict Sci Clin Pract

Self Cite

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“…After incarceration post-release interruptions in health care are common [77–80]. Therefore, PRJP are less likely than the general population to have a primary care physician and more likely to use emergency departments or experience preventable hospital admissions [79, 81, 82].…”

Section: Intermediate Determinantsmentioning

confidence: 99%

A conceptual model for understanding post-release opioid-related overdose risk

Joudrey

Khan

Wang

et al. 2019

Addict Sci Clin Pract

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137

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Post-release opioid-related overdose mortality is the leading cause of death among people released from jails or prisons (PRJP). Informed by the proximate determinants framework, this paper presents the Post-Release Opioid-Related Overdose Risk Model. It explores the underlying, intermediate, proximate and biological determinants which contribute to risk of post-release opioid-related overdose mortality. PRJP share the underlying exposure of incarceration and the increased prevalence of several moderators (chronic pain, HIV infection, trauma, race, and suicidality) of the risk of opioid-related overdose. Intermediate determinants following release from the criminal justice system include disruption of social networks, interruptions in medical care, poverty, and stigma which exacerbate underlying, and highly prevalent, substance use and mental health disorders. Subsequent proximate determinants include interruptions in substance use treatment, including access to medications for opioid use disorder, polypharmacy, polydrug use, insufficient naloxone access, and a return to solitary opioid use. This leads to the final biological determinant of reduced respiratory tolerance and finally opioid-related overdose mortality. Mitigating the risk of opioid-related overdose mortality among PRJP will require improved coordination across criminal justice, health, and community organizations to reduce barriers to social services, ensure access to health insurance, and reduce interruptions in care continuity and reduce stigma. Healthcare services and harm reduction strategies, such as safe injection sites, should be tailored to the needs of PRJP. Expanding access to opioid agonist therapy and naloxone around the post-release period could reduce overdose deaths. Programs are also needed to divert individuals with substance use disorder away from the criminal justice system and into treatment and social services, preventing incarceration exposure.

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“…Briefly, the TCN model utilizes highly trained community health workers who have the lived experience of previous incarceration to support patients newly released from incarceration in accessing a designated community clinic. These designated community clinics are designed to be responsive to the cultural, social, and economic needs of people returning to the community from correctional environments [14,15].…”

Section: Original Articlementioning

confidence: 99%

Prevalence of Chronic Health Conditions Among Adults Released From the North Carolina Prison System, 2015-2016

Rosen

Thomas

Kavee³

et al. 2019

North Carolina Medical Journal

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background In the United States each year nearly 570,000 people return from state prisons to the community. Prevalence data of chronic health problems for this population are lacking, impeding planning of health care programs to serve people with chronic conditions who are re-entering the community. method We used medication dispensing records as a proxy for diagnoses in assessing the prevalence of 10 major and 20 substituent health conditions among incarcerated people released from the North Carolina state prison system from July 2015 through June 2016. results Among 20,585 released people, 13% were female; 50% were black; 43% were white; and 4% were aged 55 years or older. Thirtythree percent had ≥ 1 condition and 13% had two or more. The prevalence of chronic health conditions was the following: psychiatric, 15%; cardiovascular, 15%; neurologic, 7%; pulmonary, 6%; diabetes mellitus, 3%; and infectious, 3%. Seventy-one percent of those aged 55 years or older had a chronic medical condition. Among those with a psychiatric condition, 56% had another chronic illness. limitations We could not identify unmedicated health conditions; medications prescribed across multiple disease categories were excluded from our analysis. conclusion In North Carolina, at least one in three people released from the state prison system had a chronic health condition, and among those with psychiatric conditions, most had comorbid medical disease. Coordination of health care after release from incarceration is essential to avoid preventable complications and unnecessary utilization of acute care services. Greater eligibility for Medicaid is needed to scale up transition programs for this population.

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Transitions Clinic Network: Challenges And Lessons In Primary Care For People Released From Prison

Cited by 93 publications

References 21 publications

Illicit substance use after release from prison among formerly incarcerated primary care patients: a cross-sectional study

Illicit substance use after release from prison among formerly incarcerated primary care patients: a cross-sectional study

A conceptual model for understanding post-release opioid-related overdose risk

Prevalence of Chronic Health Conditions Among Adults Released From the North Carolina Prison System, 2015-2016

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