Emergency Department Use among HIV-Infected Released Jail Detainees

Abstract

Release from short-term jail detention is highly destabilizing, associated with relapse to substance use, recidivism, and disrupted health care continuity. Little is known about emergency department (ED) use, potentially a surrogate for medical, psychiatric, or social instability, by people living with HIV/AIDS (PLWHA) leaving jails. All ED visits were reviewed from medical records for a cohort of 109 PLHWA in the year following release from county jail in Connecticut, between January 1, 2008 and December 31, 2010. Primary outcomes were frequency and timing of ED visits, modeled using multivariate negative binomial regression and Cox proportional hazards regression, respectively. Demographic, substance use, and psychiatric disorder severity factors were evaluated as potential covariates. . Those in late or sustained HIV care used the ED sooner than those not retained in HIV primary care (median for late retention 16.3 days, median for sustained retention 24.9 days, median for no retention not reached at 12 months, p value 0.004). Using multivariate modeling, those who used the ED earliest upon release were more likely to be homeless ]), to be retained in HIV care ), and to have recently used drugs ), yet had a low lifetime drug severity (HR 0.01 [0.00-0.14]). Among PLWHA released from jail, frequency of ED use is high, often soon after release, and is associated with social and drug-related destabilizing factors. Future interventions for this specific population should focus on addressing these resource gaps, ensuring housing, and establishing immediate linkage to HIV primary care after release from jail.

The health care utilization of people in prison and after prison release: A population-based cohort study in Ontario, Canada

“…Several studies found that compared to use by the general population, ambulatory care use was higher in prison [ 10 ], and emergency department use and hospitalization were higher post-release [ 5 , 22 , 23 ]. However, most studies conducted to date have limitations that challenge their internal and external validity, including small or select samples [ 5 , 19 – 21 , 24 ], the lack of general population comparator groups [ 11 , 12 , 14 , 15 , 17 – 21 , 24 , 25 ], the use of self-reported data [ 15 , 17 – 20 , 25 ], and the use of data from over 20 years ago [ 11 , 13 ]. Further, no studies have examined health care utilization both in prison and on release.…”

A Survey of Health Disparities, Social Determinants of Health, and Converging Morbidities in a County Jail: A Cultural-Ecological Assessment of Health Conditions in Jail Populations

“…This relatively short term stay and rapid release from jail, compared to more stable prison populations, is a significant public health challenge for individuals and communities. Incarceration makes individuals more likely to relapse to substance abuse, and non-adherence to mental and physical health treatment programs [ 17 , 18 , 19 ]. Jail residents may also become an important vector for communicable disease being cycled in and out of jail populations.…”

How do ED patients with criminal justice contact compare with other ED users? A retrospective analysis of ED visits in California

“… 10 Despite these challenges, studies that followed cohorts in the first year postrelease found high proportions of ED use, ranging from 25% to 56% after release from prison, 11 12 and 65% of individuals with HIV after release from jail. 13 National studies found individuals with past-year criminal justice involvement were more likely than the overall population to have used the ED or been hospitalised in the last year. 14 15 Other studies linked administrative data from correctional departments, hospitals and Medicare claims to show higher rates of ED visits and hospitalisations among those released from correctional institutions, particularly for mental health, substance use disorders and other ambulatory care sensitive conditions.…”