de Andrade Dominique F, Spittal Matthew J, Snow Kathryn J, Taxman Faye S, Crilly Julia L, Kinner Stuart A
Centre for Youth Substance Abuse Research, Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.
Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia.
Crim Behav Ment Health. 2019 Apr;29(2):85-93. doi: 10.1002/cbm.2106. Epub 2019 Jan 29.
Adults released from prison often have complex health needs. They are at high risk of poor health outcomes and reincarceration, with health service use unlikely to be planned.
AIMS/HYPOTHESES: To determine the incidence of emergency health service (EHS) use, ambulance attendance and/or emergency department presentation, among 1,181 adults released from Australian prisons. We hypothesised that EHS contact would be associated with increased reincarceration risk.
Baseline surveys were conducted within 6 weeks before release. Postrelease EHS contacts and reincarceration were identified through prospective data linkage. For each participant, EHS contacts within a 24-hour period were combined to make an episode. We used Cox proportional hazards regression to examine the relationship between EHS episodes and reincarceration, controlling for covariates.
More than half (53.3%) of participants had at least one EHS contact over a median of 25.6-month follow-up. In adjusted analyses, compared to those with no EHS contacts, the hazard of reincarceration was greater for participants who had one to three EHS episodes (hazard ratio [HR] = 1.84; 95% confidence interval [CI] [1.48, 2.29]) or four or more (HR = 2.35; 95% CI [1.67, 3.29]).
CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Emergency department attendance by people with a history of imprisonment may be indicative of wider decompensation. Improved management of such patients may improve health outcomes and have collateral benefits for reducing reincarceration.
从监狱释放的成年人往往有复杂的健康需求。他们健康状况不佳和再次入狱的风险很高，而且不太可能有计划地使用医疗服务。
目的/假设：确定1181名从澳大利亚监狱释放的成年人中使用紧急医疗服务（EHS）、救护车出诊和/或到急诊科就诊的发生率。我们假设与紧急医疗服务的接触会增加再次入狱的风险。
在释放前6周内进行基线调查。通过前瞻性数据链接确定释放后紧急医疗服务接触情况和再次入狱情况。对于每位参与者，将24小时内的紧急医疗服务接触合并为一次事件。我们使用Cox比例风险回归来检验紧急医疗服务事件与再次入狱之间的关系，并对协变量进行控制。
在中位随访25.6个月期间，超过一半（53.3%）的参与者至少有一次紧急医疗服务接触。在调整分析中，与没有紧急医疗服务接触的参与者相比，有1至3次紧急医疗服务事件的参与者再次入狱的风险更高（风险比[HR]=1.84；95%置信区间[CI][1.48,2.29]），有4次或更多次紧急医疗服务事件的参与者再次入狱的风险更高（HR=2.35；95%CI[1.67,3.29]）。
结论/对实践的启示：有入狱史的人到急诊科就诊可能表明存在更广泛的失代偿情况。改善对此类患者的管理可能会改善健康状况，并对减少再次入狱有附带益处。
