Low-Intensity Case Management Increases Contact with Primary Care in Recently Released Prisoners
BACKGROUND:
The
world prison population is large and growing. Poor health outcomes after
release from prison are common, but few programmes to improve health outcomes
for ex-prisoners have been rigorously evaluated. The aim of this study was to
evaluate the impact of individualised case management on contact with health
services during the first 6 months post-release.
METHODS:
Single-blinded,
randomised, controlled trial. Baseline assessment with N=1325 adult prisoners
in Queensland, Australia, within 6 weeks of expected release; follow-up
interviews 1, 3 and 6 months post-release. The intervention consisted of
provision of a personalised booklet ('Passport') at the time of release, plus
up to four brief telephone contacts in the first 4 weeks post-release.
RESULTS:
Of 1179
eligible participants, 1003 (85%) completed ≥1 follow-up interview. In
intention-to-treat analyses, 53% of the intervention group and 41% of the
control group reported contacting a general practitioner (GP) at 1 month
post-release (difference=12%, 95% CI 5% to 19%). Similar effects were observed
for GP contact at 3 months (difference=9%, 95% CI 2% to 16%) and 6 months
(difference=8%, 95% CI 1% to 15%), and for mental health (MH) service contact
at 6 months post release (difference=8%, 95% CI 3% to 14%).
CONCLUSIONS:
Individualised
case management in the month after release from prison increases usage of
primary care and MH services in adult ex-prisoners for at least 6 months
post-release. Given the poor health profile of ex-prisoners, there remains an
urgent need to develop and rigorously evaluate interventions to increase health
service contact in this profoundly marginalised population.
Below: Percentage of intervention group participants contacting a general practitioner (GP) at 1 month post release, according to number of intervention telephone calls completed
- 1Griffith Criminology Institute & Menzies Health Institute Queensland, Griffith University, Brisbane, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-UQ, The University of Queensland, Brisbane, Australia.
- 2School of Public Health, University of Queensland, Brisbane, Australia.
- 3Drug and Alcohol Services South Australia, Adelaide, Australia.
- 4Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
- 5Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-UQ, The University of Queensland, Brisbane, Australia.
- J Epidemiol Community Health. 2016 Jan 19. pii: jech-2015-206565. doi: 10.1136/jech-2015-206565.
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