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High rates of general practice attendance by former prisoners: a prospective cohort study

Megan Carroll, Matthew J Spittal, Anna R Kemp-Casey, Nicholas G Lennox, David B Preen, Georgina Sutherland and Stuart A Kinner
Med J Aust 2017; 207 (2): 75-80. || doi: 10.5694/mja16.00841

Abstract

Objectives: To determine the rates at which people recently released from prison attend general practitioners, and to describe service users and their encounters.

Design, participants and setting: Prospective cohort study of 1190 prisoners in Queensland, interviewed up to 6 weeks before expected release from custody (August 2008 – July 2010); their responses were linked prospectively with Medicare and Pharmaceutical Benefits Scheme data for the 2 years after their release. General practice attendance was compared with that of members of the general Queensland population of the same sex and in the same age groups.

Main outcome measures: Rates of general practice attendance by former prisoners during the 2 years following their release from prison.

Results: In the 2 years following release from custody, former prisoners attended general practice services twice as frequently (standardised rate ratio, 2.04; 95% CI, 2.00–2.07) as other Queenslanders; 87% of participants visited a GP at least once during this time. 42% of encounters resulted in a filled prescription, and 12% in diagnostic testing. Factors associated with higher rates of general practice attendance included history of risky opiate use (incidence rate ratio [IRR], 2.09; 95% CI, 1.65–2.65), having ever been diagnosed with a mental disorder (IRR, 1.32; 95% CI, 1.14–1.53), and receiving medication while in prison (IRR, 1.82; 95% CI, 1.58–2.10).

Conclusions: Former prisoners visited general practice services with greater frequency than the general Queensland population. This is consistent with their complex health needs, and suggests that increasing access to primary care to improve the health of former prisoners may be insufficient, and should be accompanied by improving the quality, continuity, and cultural appropriateness of care.

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  • Megan Carroll1
  • Matthew J Spittal1
  • Anna R Kemp-Casey2,3
  • Nicholas G Lennox4
  • David B Preen5
  • Georgina Sutherland1
  • Stuart A Kinner1,6,7

  • 1 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
  • 2 Centre for Health Services Research, University of Western Australia, Perth, WA
  • 3 Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, SA
  • 4 Queensland Centre for Intellectual and Developmental Disability, Brisbane, QLD
  • 5 University of Western Australia, Perth, WA
  • 6 Griffith Criminology Institute, Griffith University, Brisbane, QLD
  • 7 Menzies Health Institute Queensland, Griffith University, Brisbane, QLD


Acknowledgements: 

We thank Queensland Corrective Services for assistance with data collection, and Passports study participants for sharing their stories. We acknowledge the Australian Government Department of Human Services as the source of Medicare and Pharmaceutical Benefits Scheme (PBS) records. The Passports study was funded by a National Health and Medical Research Council (NHMRC) Strategic Award (409966). The HIP-Aus study is funded by a National Health and Medical Research Council Project grant (1002463). Stuart Kinner is supported by an NHMRC Senior Research Fellowship (APP1078168). The views expressed in this article are solely those of the authors, and in no way reflect the views or policies of Queensland Corrective Services.

Competing interests:

No relevant disclosures.

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