Primary care utilization in people who experience imprisonment in Ontario, Canada: a retrospective cohort study

• Published in: BMC health services research Vol. 18; no. 1; p. 845
• Main Authors: Kouyoumdjian, Fiona G, Cheng, Stephanie Y, Fung, Kinwah, Humphreys-Mahaffey, Stephen, Orkin, Aaron M, Kendall, Claire, Kiefer, Lori, Matheson, Flora I, Green, Samantha E, Hwang, Stephen W
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 09-11-2018; BioMed Central; BMC
• Subjects: Adult; Ambulatory Care - statistics & numerical data; Chronic Disease - therapy; Chronic obstructive pulmonary disease; Cohort analysis; Community Health Services - statistics & numerical data; Comorbidity; Correctional institutions; Criminal sentences; Demographic aspects; Ex-convicts; Facilities and Services Utilization; Family physicians; Female; Forecasts and trends; General Practice - statistics & numerical data; Health aspects; Health care policy; Health insurance; Health services utilization; Healthcare utilization; Humans; Imprisonment; Male; Medical care utilization; Mortality; Ontario; Patient Acceptance of Health Care - statistics & numerical data; Physicians; Population; Primary care; Primary health care; Primary Health Care - statistics & numerical data; Prison; Prisoners; Prisoners - statistics & numerical data; Prisons - statistics & numerical data; Retrospective Studies; Self report; User statistics; Ontario; Canada; Ontario Canada; United States > US; Prison; Healthcare utilization; Primary care
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-018-3660-2

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.
We 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.
Compared 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.
Primary 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.