Since individuals released from prison have high rates of chronic conditions but minimal engagement in primary care, the current study compared two interventions designed to improve primary care engagement and reduce acute care use.
The two interventions were Transitions Clinic, a primary care–based care management program with a community health worker, compared with expedited primary care. A randomized controlled trial was conducted from 2007 to 2009 among 200 recently released prisoners who had a chronic medical condition or were older than 50 years. Outcomes after 12 months were abstracted from an electronic repository available from the safety-net health care system. Main outcomes were (1) primary care use (two or more visits to the assigned primary care clinic) and (2) emergency department (ED) use (the proportion of participants making any ED visit). Both groups had similar rates of primary care use (37.7 percent vs 47.1 percent; P = .18). Transitions Clinic participants had lower rates of ED use (25.5 percent vs 39.2 percent; P = .04). The study concluded that chronically ill patients leaving prison will engage in primary care if provided early access. The addition of a primary care–based care management program tailored for returning prisoners reduces ED use compared with expedited primary care. (publisher abstract modified)