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Caring for Ex-Prisoners Presents Management Challenges

From the September 2017 ACP Internist

When caring for patients who have been released from prison, internists must consider the economic and social obstacles that can impact the plan of care, as well as the difficulty of coordinating with jails and prisons and obtaining patients' medical records.

A young man incarcerated as a juvenile is newly diagnosed with diabetes while in prison. His disease is well managed during incarceration, but he never learns how to manage it on his own. Upon release, seeing a physician becomes a low priority as he's faced with the more immediate problems of finding food, employment, and housing.

It's a typical case for physicians working in the Transitions Clinic Network (TCN), a national consortium of community health centers that coordinates with correctional agencies to connect recently released prisoners with health care. Many of these patients are diagnosed with chronic illnesses and started on medications while incarcerated but struggle to manage their symptoms after release, said Emily Wang, MD, TCN cofounder and associate professor at the Yale School of Medicine in New Haven, CT.

“When released, these patients have issues unique to having been incarcerated and face huge barriers to managing their disease on top of the standard barriers all patients face,” she said. “They often have an entirely different understanding of how to manage their disease compared with patients in the general community.”

When caring for patients who have been released, internists must consider the economic and social obstacles that can impact the plan of care. Added to those impediments is the difficulty of coordinating with jails and prisons and obtaining patients' medical records.

According to a study published in the June 2017 Health Affairs, coauthored by Dr. Wang, about 80% of people released from prison have chronic medical, psychiatric, or substance abuse disorders, but care coordination is rare to nonexistent between prison and community health care settings. Many prisoners are never referred to a community physician or clinic or given their medical records upon release. Although the Affordable Care Act (ACA) allowed many former prisoners to become insured under Medicaid after 2014, insurance is only one among many barriers.

“The people we see have often lost their trust in the system after getting the short end of the stick many times,” said Sam Tri, MD, a primary care physician working in a homeless clinic in Albuquerque, NM, where about half of the patients are newly released from prison. “Just trying to build that trust back up and convincing them that we're on their side is a lot of what we do.”

Read the full article in ACP Internist.

ACP Internist provides news and information for internists about the practice of medicine and reports on the policies, products, and activities of ACP.

Back to the October 2017 issue of ACP IMpact