Engaging individuals recently released from prison into primary care: a randomized trial

Abstract

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.

FIGURE 1—

Enrollment and treatment of individuals (n = 200) released from California state prisons, 2007–2009.

FIGURE 2—

Participant visits to emergency department in year following enrollment among individuals (n = 200) released from California state prisons, 2007–2009. Note. Wilcoxon rank sum test P = .015.