Journal of correctional health care : the official journal of the National Commission on Correctional Health Care最新文献

This article examines mental health service use among 395 incarcerated individuals with opioid use disorder in 14 prison-based substance use programs, as part of the Geographic Variation in Addiction Treatment Experiences Study. It explores how mental health symptoms and loneliness relate to service utilization using two multivariate logistic regression models for before incarceration and during incarceration. Utilization rose from 19% before incarceration to 38% during incarceration. While 78% of individuals met criteria for depression and 58% met criteria for anxiety, neither predicted service use. In contrast, loneliness was significantly associated with greater utilization during incarceration (adjusted odds ratio: 1.14, p = .026). These findings highlight loneliness as a key driver of mental health service use in incarcerated populations, consistent with general population trends. Further research should explore the role of social networks in shaping service utilization in correctional settings.

Increasing numbers of people require palliative end-of-life care (PEOLC) within prison settings, mainly because of aging populations and increasingly long sentences. There is limited research in this area, but evidence suggests that prisons possess limited resources to provide adequate care for aging and frail people at the end of life. This study aimed to explore how PEOLC is provided in prisons in different countries and identify factors that facilitate or impede its provision. A cross-sectional qualitative study using semistructured interviews was utilized to interview prison and health care staff involved in the organization and/or delivery of PEOLC to incarcerated adults in six countries. Sampling was purposive and adopted a snowball technique. Data were analyzed using framework analysis. This study provides evidence that numerous barriers exist that can impede the organization and delivery of PEOLC to people in prison, including barriers at the individual, staff, organization, and regulatory levels. Facilitators coexisted alongside the barriers. Similar barriers and facilitators were identified in each country. Despite some good practices, multiple challenges remain in providing the same quality of PEOLC that is available outside prison, and thus, those dying in prison continue to be disadvantaged.

The medical needs of the incarcerated population in the United States are growing, requiring appropriate management within the carceral health care system. This article examines adherence to prescribing guidelines for common vascular risk factors among incarcerated patients referred for vascular surgery evaluation in North Carolina between 2019 and 2023. Medical records of 57 patients with noncoronary atherosclerotic disease were reviewed. At referral, 66.6% were prescribed an antiplatelet agent, and 61.4% were on a statin, with 49.1% receiving both. Among the 82.5% with hypertension, 87.2% were prescribed antihypertensives. Of the 50.8% with diabetes, 72.4% received antihyperglycemics, and among patients with hyperlipidemia (43.9% of the total), 84.0% were prescribed lipid-lowering medication. Although treatment of hypertension and diabetes was generally guideline-concordant, gaps remain in statin and antiplatelet prescribing.

Incarcerated people are disproportionately impacted by the hepatitis C virus (HCV). The purpose of this needs assessment was to characterize the population of incarcerated people with anti-HCV antibodies in one county jail system and assess the readiness of medical staff and patients for scaling up jail-based treatment. Logistic regression was used to identify factors associated with new HCV diagnoses in a retrospective cohort of patients completing HCV antibody and viral load testing between 2016 and 2021. Semistructured interviews were also conducted with 31 incarcerated people and 6 jail health services staff and thematically analyzed to identify barriers to and facilitators of jail-based HCV treatment. Of 6,282 people completing HCV antibody testing between 2016 and 2021, 79 (1.3%) were incarcerated long enough with a confirmed, active HCV infection to be cured, but were not. Of the incarcerated interviewees, 36% (8 people) preferred jail-based treatment of HCV. Jail health services staff were universally ready and willing to provide treatment in jail, should the budget allow. Many incarcerated people can be successfully diagnosed and cured of HCV in jail, and both incarcerated people and those who provide their health care desire jail-based treatment.

Providing medications for opioid use disorder (MOUD) in correctional settings is a critical tool for addressing opioid overdose. However, access to MOUD remains limited in rural county jails. This article describes a simple, community-based initiative where a rural community primary care clinic partnered with a county jail to provide MOUD care via telemedicine. This initiative was a local response to expanding jail-based MOUD after the jail's contracted health provider declined to offer these services. Between 2022 and mid-2024, 31 incarcerated patients received MOUD, representing approximately 10% of the clinic's total MOUD patients. More than half (58%) had received MOUD in the past, whereas 42% of patients were new to MOUD. Nearly a third of patients either maintained or established relationships with the clinic for postrelease care. Implementation involved a brief planning period and iterative plan-do-study-act cycles to address logistical challenges, including dosing frequency, referral processes, and diversion concerns. The initiative relied on State Opioid Response grants for funding and preexisting community partnerships fostered by a countywide overdose prevention initiative. This local, community-driven model highlights the potential for expanding MOUD access in small, rural jails. It emphasizes the value of flexible telemedicine delivery and strong collaboration between clinics and jail staff.

Incarceration is a significant stressor with long-term health implications. Limited autonomy in jail restricts stress-reducing opportunities, but recreation time (rec-time) may help mitigate stress. We estimated the association between rec-time attendance and stress among people incarcerated in a rural Southwestern U.S. jail. From 2017 to 2018, we recruited participants from Coconino County Detention Facility for a cross-sectional health study. Participants completed the Perceived Stress Scale (PSS) and reported rec-time attendance. A log-binomial regression estimated prevalence ratios for rec-time and stress. Among 199 participants, those who never attended rec-time had higher stress levels (PSS score greater than 8) than those who always attended, including in the past 24 hours (percentile rank = 2.08, 95% confidence interval: 1.23, 3.52). Regular rec-time attendance may reduce stress, warranting further research on causal links and activity types.

Around the United States, carceral medical records are often sequestered from incarcerated patients and their external physicians, hampering the provision of both acute and transitional care. Despite laws meant to ensure better ownership and portability of electronic health records (EHRs), many carceral institutions have not implemented interoperable systems, nor do incarcerated patients have easy access to their medical information. These issues can compromise care for a patient population that experiences higher rates of many diseases, hospitalization, and death compared with the general public. This article provides a review of health information legislation by a multidisciplinary group of attorneys and physicians with a targeted literature review discussing the current state of medical record access for patients behind bars, the health dangers associated with this lack of access, and solutions to improve the equity of EHR access.

Opioid education and naloxone distribution (OEND) programs are evidence-based interventions effective in reducing opioid-related deaths among adults but remain underutilized in juvenile detention settings. Our quality improvement initiative aimed to address this gap by implementing and evaluating an OEND program at a San Diego juvenile detention facility. The primary goal was to increase the percentage of youth receiving opioid education and naloxone simulation training from 0% to 50% over 6 months (March-August 2023). The secondary aim assessed training impact through surveys. Participation was voluntary. A generalized mixed-effects model analyzed survey responses. More than 50% (n = 51) of residents participated, with significant improvement in opioid identification, overdose recognition, and response confidence (p < .05). Simulation was completed by 48 of 51 participants. There was no disruption in clinical workflow.

Hepatitis C virus (HCV) infections are a leading cause of liver disease and liver cancer in the United States. Due to the intersection of substance use disorders and incarceration, HCV prevalence is far higher among criminal legal system-involved individuals than in the general population. To avoid the harms associated with incarceration, increasing efforts have been made to divert people away from jail and prison. Yet, there are few data on the HCV care cascade among people with HCV engaged in alternative-to-incarceration (ATI) programs. Here we provide background on the history of ATI programs in the United States, highlight the importance of engaging people living with HCV in ATI programs, present case examples of programs that have incorporated HCV-specific services, and discuss potential challenges and solutions to scaling up HCV-related services in ATI programs.