Kentucky Prison Pharmacy Services: Accomplishments, Issues and Recommendations

Background

The national prison population is increasing, is aging, is disproportionately minority, and has a higher prevalence of substance abuse, infectious diseases, mental health problems, chronic diseases and reproductive and sexual health problems. These conditions are exacerbated by high risk health behaviors, lack of access to continuous medical care and low socioeconomic status prior to incarceration. The majority of inmates are released back to their communities although high rates of recidivism result in the “revolving door” phenomenon. These factors result in substantial financial pressure for corrections medical systems. The three largest components of health care costs are hospital care, physician and clinical services, and pharmaceutical services. Health care costs comprise the fastest growing budgetary component of total inmate costs.

A public/private partnership has been formed between the University of Kentucky (UK), the Kentucky Department of Corrections (KyDOC) and a private health care management company, Correct Care Integrated Health (CC-IH). This partnership seeks to develop an improved, cost effective, and more integrated healthcare system for the state's inmate population.

Study Site

There are 13 state operated prisons in Kentucky housing just over 12,000 inmates.

Method

Using reviews of medical and pharmacy records, interviews, facility tours, observations, and quantitative/qualitative analyses of available data this research investigates the various strategies the Kentucky Department of Corrections has implemented to contain the costs of pharmaceutical services, while simultaneously promoting high quality inmate medical care.

Findings

Improvements in the pharmaceutical service delivery system have included the negotiation of a well defined and closely monitored contract with a pharmaceutical company, the use of an electronic medical record system, the formation of a Pharmaceutical & Therapeutics Committee, the utilization of a drug formulary, and a formal utilization review and pre-authorization processes.

The challenges facing the system include over-utilization and poly pharmacy, delay in initiation of therapy at intake facilities, non compliance by inmates and an inefficient medication administration system.

Future opportunities include greater use of medical information technologies; the implementation of ongoing quality improvement initiatives such as clinical audits, educational programs for providers, and reviews of provider prescribing patterns; updating of clinical pharmacy standards and protocols; the implementation of a 340b program and case management for high cost acutely ill inmates.

Conclusion

Despite the unique challenges faced by health care providers in the corrections environment, many quality improvement and cost containment strategies used in the non incarcerated environment can be successfully implemented in this setting.