Social Emergency Medicine
Background: More than seven million adults live within the United States correctional system. A history of incarceration is associated with poor long-term health status, including a significant burden of chronic diseases, high rates of substance abuse, and an increased risk of disability. Despite this, the views of people with a history of incarceration regarding health and healthcare access has yet to be described. The primary objective of this study was to identify both facilitators and barriers to accessing health care in the immediate reentry period after incarceration.
Methods: Semi-structured, open-ended interviews were conducted at a social service organization with individuals with a recent history of incarceration (n=20). Each interview was transcribed and coded by two investigators. Interviews were conducted until consensus on thematic saturation was reached. A modified grounded theory approach was used for analysis with theme identification by consensus.
Results: The majority of participants were male (90%) and African-American (80%). Over half of participants were aged 26-45. A majority (55%) of the participants had one or more chronic medical conditions, 40% reported active substance addiction, and 75% reported a chronic psychiatric condition. Almost all participants had Medicaid as their insurance coverage, while the remainder were uninsured. In qualitative analysis, participants described the three biggest facilitators to accessing health care as eligibility for Medicaid, support through reentry organizations and online resources. Participants cited the major barriers to accessing health care were multiple and competing priorities, limitations of Medicaid and lack of access to health records. Additionally, regarding preferences on care settings, participants reported choosing the emergency department for acute conditions or symptoms and preferred it for its accessibility and thoroughness.
Conclusion: Our population had chronic medical conditions, including substance use and mental health problems, and faced many competing priorities during re-entry, such as housing, employment and avoiding substance use relapse. Emergency physicians should be aware of unique challenges faced by this vulnerable population and refer to re-integration organizations when appropriate.