A randomized controlled trial on the use of patient navigators to facilitate health outcomes in formerly incarcerated individuals during community re-entry

Background:  Formerly incarcerated individuals have disproportionately high rates of HIV infection and other chronic diseases and must overcome socioeconomic and structural barriers in order to access healthcare.  This study examines the impact of peer-based patient navigators versus usual care to improve medical outcomes in formerly incarcerated individuals as they transition into the community. Studies have shown the efficacy of patient navigators in improving healthcare utilization and outcomes in marginalized populations, but it has not yet been examined among formerly incarcerated individuals.

Method: Eligible patients were randomly assigned to the patient navigator (PN) intervention or usual care. The patient navigators were provided training in motivational interviewing and health education. PNs assisted patients with follow-up appointments, obtaining/taking medications, transportation, linking/escorting patients to social services. Demographic and clinical data were extracted from the electronic medical record.

Results:   We have enrolled 104 patients with 52 patients randomized to each arm (patient navigator intervention and treatment as usual. Mean age of patients is 46 years (range of 21-68 years of age). The majority of participants are: male (90%), single (70%), Black, non-Hispanic (48%), Hispanic/Latino (36%), Medicaid recipients (84%), and have children (48%). Median time from release to enrollment was 2 months (range of 0-6 months). The majority of participants were incarcerated in the prison system (84%) with a mean duration of incarceration of 6 years (0-32 years). There is a high prevalence in participants of chronic medical illness (67%) and mental health disorder (47%) at enrollment. Hypertension (40%), hyperlipidemia (25%), and HIV infection (15%) are the most common chronic medical conditions, while depression is seen in 26% of participants. Nearly two-thirds of participants reported a history of substance abuse or dependence, most commonly involving cocaine (38%) and cannabis (32%).

Conclusions:  Preliminary results reveal a high prevalence of chronic disease, substance use, and mental illness in our patient population and a trend towards better health outcomes in patients assigned to a patient navigator intervention (at 6 month follow-ups).