Factors affecting medical care utilization by Kentucky state prison inmates

Background

The inmate population is increasing, aging and generally in poorer health than the non-incarcerated population. Providing healthcare to inmates is constitutionally mandated, and expensive. Little published research exists regarding within facility healthcare utilization by inmates, or healthcare provided to inmates at institutions located outside the prison. Such information could assist corrections health policy makers to strategically plan for future inmate healthcare needs.

Objectives

This study was a cross-sectional, retrospective examination of healthcare data of 577 Kentucky Department of Corrections inmates, incarcerated at twelve state operated prisons in Kentucky during the period January 1, 2007 to December 31, 2007 with a diagnosis of diabetes mellitus and/or hypertension and/or hyperlipidemia. The objective was to identify factors associated with inmates' within facility medical care utilization and their receipt of secondary care at healthcare facilities located outside the prison.

Methods

Negative binomial regression was used for the analysis of within facility medical care utilization and logistic regression was used to analyze secondary care utilization. The explanatory variables included demographic variables, health status variables, health risk factors, sentence-related variables, facility characteristics, inmate to corrections and medical staff ratios and quality of care indicators.

Results

Regression analysis indicated that having more problems listed in the inmate's electronic health record and having a diagnosis of diabetes were statistically significantly associated with more documented encounters with medical healthcare providers. Adhering to diet, having no provider documentation on adherence to diet, physical activity and medication and having no Framingham Risk Index score were statistically significantly associated with fewer documented encounters with medical care providers. A greater number of problems listed in an inmates' electronic health record and increasing age were statistically significantly associated with increased secondary healthcare utilization.

Recommendations for Healthcare Administrators

Effective strategic planning regarding the provision of healthcare services to this population group requires data-based knowledge of the healthcare utilization patterns of inmates. The use of an electronic health record facilitates population-based decision making. A useful data-collection and analysis tool used elsewhere is a balanced score card. Collaboration between Departments of Corrections and academic research institutions can facilitate the translation of research into practice. Other suggested strategies to reduce secondary care utilization and improve inmate healthcare include case management and disease management for inmates with comorbidities, providing health education and improving health literacy and using inmates as community healthcare workers.