Binswanger Ingrid A, Whitley Elizabeth, Haffey Paul-Ryan, Mueller Shane R, Min Sung-Joon
a Division of General Internal Medicine , University of Colorado School of Medicine , Aurora , Colorado , USA.
Subst Abus. 2015;36(1):34-41. doi: 10.1080/08897077.2014.932320. Epub 2014 Jun 24.
Former prison inmates experience high rates of hospitalizations and death during the transition from prison to the community, particularly from drug-related causes and early after release. The authors designed a randomized controlled trial (RCT) of patient navigation to reduce barriers to health care and hospitalizations for former prison inmates.
Forty former prison inmates with a history of drug involvement were recruited and randomized within 15 days after prison release. Participants were randomized to receive 3 months of patient navigation (PN) with facilitated enrollment into an indigent care discount program (intervention) or facilitated enrollment into an indigent care discount program alone (control). Structured interviews were conducted at baseline, 3 months, and 6 months. Outcomes were measured as a change in self-reported barriers to care and as the rate of health service use per 100 person-days.
The mean number of reported barriers to care was reduced at 3 and 6 months in both groups. At 6 months, the rate of emergency department/urgent care visits per 100 person-days since baseline was 1.1 among intervention participants and 0.5 among control participants (P = .04), whereas the rate of hospitalizations per 100 person-days was 0.2 in intervention participants and 0.6 in control participants (P = .04).
Recruitment of former inmates into an RCT of patient navigation was highly feasible, but follow-up was limited by rearrests. Results suggest a significantly lower rate of hospitalizations among navigation participants, although the rate of emergency department/urgent care visits was not improved. Patient navigation is a promising, pragmatic intervention that may be effective at reducing high-cost health care utilization in former prison inmates.
从前的监狱囚犯在从监狱过渡到社区期间，住院率和死亡率很高，尤其是因与毒品相关的原因以及释放后不久。作者设计了一项患者导航随机对照试验（RCT），以减少从前的监狱囚犯获得医疗保健和住院治疗的障碍。
招募了40名有吸毒史的从前的监狱囚犯，并在出狱后15天内进行随机分组。参与者被随机分配接受3个月的患者导航（PN），并协助其加入贫困护理折扣计划（干预组），或仅协助其加入贫困护理折扣计划（对照组）。在基线、3个月和6个月时进行结构化访谈。结果以自我报告的护理障碍变化以及每100人日的卫生服务使用率来衡量。
两组在3个月和6个月时报告的护理障碍平均数量均有所减少。在6个月时，自基线以来干预组参与者每100人日的急诊科/紧急护理就诊率为1.1，对照组为0.5（P = 0.04），而干预组参与者每100人日的住院率为0.2，对照组为0.6（P = 0.04）。
将从前的囚犯纳入患者导航随机对照试验的招募工作非常可行，但随访受到再次被捕的限制。结果表明，导航参与者的住院率显著较低，尽管急诊科/紧急护理就诊率没有改善。患者导航是一种有前景的务实干预措施，可能有效减少从前的监狱囚犯的高成本医疗保健使用。
