Early primary care physician contact and health service utilisation in a large sample of recently released ex-prisoners in Australia: prospective cohort study

• Published in: BMJ open Vol. 5; no. 6; p. e008021
• Main Authors: Young, Jesse T, Arnold-Reed, Diane, Preen, David, Bulsara, Max, Lennox, Nick, Kinner, Stuart A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 11.06.2015; BMJ Publishing Group
• Subjects: Adult; Ambulatory care; Ambulatory Care - organization & administration; Ambulatory Care - statistics & numerical data; Australia - epidemiology; Chronic illnesses; Continuity of care; Emergency medical care; Family physicians; Female; Follow-Up Studies; Health Services - statistics & numerical data; Health Services Research; Health services utilization; Hepatitis C; Hospitalization - statistics & numerical data; Hospitals; Humans; Imprisonment; Interviews; Male; Mental disorders; Mental health care; Mental Health Services - statistics & numerical data; Physicians, Primary Care; Primary care; Primary Health Care - organization & administration; Primary Health Care - statistics & numerical data; Prisoners; Prisoners - psychology; Prisoners - statistics & numerical data; Prisons; Prospective Studies; Sociodemographics; Supervision; Time Factors; Queensland Australia; Australia; UTILISATION; HEALTH SERVICES; GENERAL PRACTITIONER; PRISONERS; PHYSICIANS; PRIMARY CARE
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2015-008021

ObjectiveTo describe the association between ex-prisoner primary care physician contact within 1 month of prison release and health service utilisation in the 6 months following release.DesignA cohort from the Passports study with a mean follow-up of 219 (±44) days postrelease. Associations were assessed using a multivariate Andersen-Gill model, controlling for a range of other factors.SettingFace-to-face, baseline interviews were conducted in a sample of prisoners within 6 weeks of expected release from seven prisons in Queensland, Australia, from 2008 to 2010, with telephone follow-up interviews 1, 3 and 6 months postrelease.ParticipantsFrom an original population-based sample of 1325 sentenced adult (≥18 years) prisoners, 478 participants were excluded due to not being released from prison during follow-up (n=7, 0.5%), loss to follow-up (n=257, 19.4%), or lacking exposure data (n=214, 16.2%). A total of 847 (63.9%) participants were included in the analyses.ExposurePrimary care physician contact within 1 month of follow-up as a dichotomous measure.Main outcome measuresAdjusted time-to-event hazard rates for hospital, mental health, alcohol and other drug and subsequent primary care physician service utilisations assessed as multiple failure time-interval data.ResultsPrimary care physician contact prevalence within 1 month of follow-up was 46.5%. One-month primary care physician contact was positively associated with hospital (adjusted HR (AHR)=2.07; 95% CI 1.39 to 3.09), mental health (AHR=1.65; 95% CI 1.24 to 2.19), alcohol and other drug (AHR=1.48; 95% CI 1.15 to 1.90) and subsequent primary care physician service utilisation (AHR=1.47; 95% CI 1.26 to 1.72) over 6 months of follow-up.ConclusionsEngagement with primary care physician services soon after prison release increases health service utilisation during the critical community transition period for ex-prisoners.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12608000232336).