Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States of America.
School of Communication, Writing and the Arts, Department of Professional Communication, Metropolitan State University, Saint Paul, MN, United States of America.
PLoS One. 2021 Jul 14;16(7):e0254578. doi: 10.1371/journal.pone.0254578. eCollection 2021.
In 2016, over 11 million individuals were admitted to prisons and jails in the United States. Because the majority of these individuals will return to the community, addressing their health needs requires coordination between community and correctional health care providers. However, few systems exist to facilitate this process and little is known about how physicians perceive and manage these transitions.
The goal of this study was to characterize physicians' views on transitions both into and out of incarceration and describe how knowledge of a patient's criminal justice involvement impacts patient care plans.
Semi-structured interviews were conducted between October 2018 and May 2019 with physicians from three community clinics in Hennepin County, Minnesota. Team members used a hybrid approach of deductive and inductive coding, in which a priori codes were defined based on the interview guide while also allowing for data-driven codes to emerge.
Four themes emerged related to physicians' perceptions on continuity of care for patients with criminal justice involvement. Physicians identified disruptions in patient-physician relationships, barriers to accessing prescription medications, disruptions in insurance coverage, and problems with sharing medical records, as factors contributing to discontinuity of care for patients entering and exiting incarceration. These factors impacted patients differently depending on the direction of the transition.
Our findings identified four disruptions to continuity of care that physicians viewed as key barriers to successful transitions into and out of incarceration. These disruptions are unlikely to be effectively addressed at the provider level and will require system-level changes, which Medicaid and managed care organizations could play a leading role in developing.
2016 年，超过 1100 万人被送进美国的监狱和看守所。由于这些人中的大多数将返回社区，因此需要社区和惩教保健提供者之间进行协调，以满足他们的健康需求。但是，很少有系统能够促进这一过程，并且对于医生如何看待和管理这些过渡知之甚少。
本研究的目的是描述医生对监禁内外过渡的看法，并描述对患者刑事司法参与的了解如何影响患者护理计划。
2018 年 10 月至 2019 年 5 月，在明尼苏达州亨内平县的三家社区诊所对医生进行了半结构式访谈。团队成员使用演绎和归纳相结合的混合编码方法，根据访谈指南定义了预先确定的代码，同时也允许出现基于数据的代码。
有四个主题与医生对具有刑事司法参与的患者护理连续性的看法有关。医生确定了患者与医生关系的中断、获取处方药物的障碍、保险覆盖的中断以及医疗记录共享的问题，这些因素导致了进出监禁的患者护理连续性中断。这些因素根据过渡的方向对患者产生不同的影响。
我们的研究结果确定了连续性护理的四个中断，医生认为这些中断是成功过渡到监禁内外的关键障碍。这些中断不太可能在提供者层面上得到有效解决，需要系统层面的改变，而医疗补助和管理式医疗组织可以在制定这些改变方面发挥主导作用。
