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Abstract
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BACKGROUND: Former prison inmates experience high rates of hospitalizations and death during the transition from prison to the community, particularly from drug-related causes and early after release. We designed a randomized controlled trial (RCT) of patient navigation to reduce barriers to healthcare and hospitalizations for former prison inmates.
METHODS: Forty former prison inmates with a history of drug involvement were recruited and randomized within 15 days after prison release. Participants were randomized to receive three months of patient navigation (PN) with facilitated enrollment into an indigent care discount program (intervention) or facilitated enrollment into an indigent care discount program alone (control). Structured interviews were conducted at baseline, three and six months. Outcomes were measured as a change in self-reported barriers to care and as the rate of health service use per 100 person days.
RESULTS: The mean number of reported barriers to care was reduced at three months and six months in both groups. At six months, the rate of emergency department/urgent care visits per 100 person days since baseline was 1.1 among intervention participants and 0.5 among control participants (p = 0.04) whereas the rate of hospitalizations per 100 person days was 0.2 in intervention participants and 0.6 in control participants (p = 0.04).
CONCLUSIONS: Recruitment of former inmates into an RCT of patient navigation was highly feasible, but follow-up was limited by re-arrests.
RESULTS suggest a significantly lower rate of hospitalizations among navigation participants, although the rate of emergency department/ urgent care visits was not improved. Patient navigation is a promising, pragmatic intervention that may be effective at reducing high-cost health care utilization in former prison inmates.
Keywords: Suicide misclassification
Language: en |