Diabetes Care in the San Francisco County Jail

2014

Implementation and adherence to screening recommendations of Type 2 Diabetes (T2D) clinical practice guidelines are associated with earlier diagnosis and treatment. Standardized T2D screening helps ensure consistency of care and decrease unnecessary testing by targeting those at greatest risk for developing the disease. The aim of this quality improvement pilot project was to facilitate standardized T2D screening of inmates within a correctional system. The number and frequency of selected preexisting major T2D risk factors identified within a sample of inmates diagnosed during incarceration were described. A clinical panel reviewed these data and identified the guideline that best addressed T2D risk in the sample. Implementation of guideline screening recommendations as a prospective quality improvement study in a broader sample was proposed prior to considering statewide application.

Int J Public Health, 2016

Objectives To document the performance of diabetes and hypertension care in two large male prisons in Mexico City. Methods We analyzed data from a cross-sectional study carried out during July–September 2010, including 496 prisoners with hypertension or diabetes in Mexico City. Bivariate and multivariable logistic regressions were used to assess process-of-care indicators and disease control status. Results Hypertension and diabetes prevalence were estimated on 2.1 and 1.4 %, respectively. Among prisoners with diabetes 22.7 % (n = 62) had hypertension as comorbidity. Low achievement of process-of-care indicators—follow-up visits, blood pressure and laboratory assessments—were observed during incarceration compared to the same prisoners in the year prior to incarceration. In contrast to nonimprisoned diabetes population from Mexico City and from the lowest quintile of socioeconomic status at the national level, prisoners with diabetes had the lowest performance on process-of-care indicators. Conclusions Continuity of care for chronic diseases, coupled with the equivalence of care principle, should provide the basis for designing chronic disease health policy for prisoners, with the goal of consistent transition of care from community to prison and vice versa.

Journal of Forensic and Legal Medicine, 2020

The study explored health related quality of life of prisoners with diabetes mellitus (DM).48 male inmates incarcerated in a Greek prison, completed a demographic and clinical traits questionnaire. Prisoners with DM and those with additional health problems had worse physical, mental health and psychological well-being outcomes (p = 0.002, p< 0.001 and p = 0.014 respectively). People with DM in correctional facilities should receive specialized primary health care services either health services within the correctional institution or community liaison. The implementation of services targeting DM should be evaluated with the target of improving offenders' physical and mental health.

Annals of Epidemiology, 2019

Purpose: Diabetes is one of the most prevalent and fastest-growing adverse health conditions in the United States and disproportionately affects those demographic and socioeconomic groups that are also more likely to be involved with the criminal justice (CJ) system. This study examines the prevalence and correlates of diabetes among CJ-involved individuals in the United States. Methods: Using traditional statistical modeling and modern machine learning methods, data from the National Study on Drug Use and Health were analyzed to compare the correlates and predictive interactions of diabetes diagnosis among those respondents on probation and parole to a sample, matched by age and gender, who were not. Results: Subjects involved in the CJ system were 15% more likely (1.66% vs. 1.44%, P ¼ .015) to report a past-year diagnosis of diabetes than a sample of noninvolved individuals matched by age and sex, although this association was not statistically significant after adjusting for demographic and behavioral confounders. Similar trends in diabetes prevalence emerged for the non-CJ and CJ groups with regard to income, depression (OR of 2.38 and 1.65 for the CJ and non-CJ groups, respectively) and attainment of college education (OR of 0.64 and 0.30 for the CJ and non-CJ groups, respectively, compared with those with less than a high school education). Results also suggested that a generally high propensity toward risk taking had a negative effect on diabetes for the non-CJ group (OR 0.78; 95% CI 0.69e0.87), yet increased the odds of diabetes (OR 1.38; 95% CI 1.02e1.85) for the CJ group. Conclusions: Involvement in the U.S. CJ system is correlated with a higher prevalence of diabetes and differing risk factors for diabetes diagnosis. Further research is necessary, however, to unpack the precise causal pathways that underlie the associational trends in the current analysis.

Journal of Health Care for the Poor and Underserved, 2012

U.S. prisons have a court-affirmed mandate to provide health care to prisoners. Given this mandate, we sought to determine whether use of prison health care was equitable across race using a nationally-representative sample of Black and White male state prisoners. We first examined the prevalence of health conditions by race. Then, across all health conditions and for each of 15 conditions, we compared the proportion of Black and White male prisoners with the condition who received health care. For most conditions including cancer, heart disease, and liver-related disorders, the age-adjusted prevalence of disease among Blacks was lower than among Whites (p<.05). Blacks were also modestly more likely than Whites to use health care for existing conditions (p<.05), particularly hypertension, cerebral vascular accident/brain injury, cirrhosis, flu-like illness, and injury. The observed racial disparities in health and health care use are different from those among non-incarcerated populations. Keywords Prisoners; health disparities; access to health care; health care systems Remarkably, the incarceration rate among U.S. adults now exceeds one in 100, and 1.6 million adults are currently serving sentences in state or federal prisons. 1,2 Many of these prisoners have engaged in illicit and non-illicit behaviors that can be harmful to health. For example, in national surveys, 57% of state prisoners reported drug use in the month prior to their offense, 3 and 50% of prisoners report being current smokers. 4 Additionally, before imprisonment many inmates resided in impoverished communities and had diminished access to health care. 5-7 Several reports suggest that prison populations have a high burden of disease, 3,4,8-11 and as correctional populations grow-and age-a wider spectrum of medical and mental health conditions will become increasingly prevalent within U.S. prisons. 12

BJGP open, 2019

Background: The size and mean age of the prison population has increased rapidly in recent years. Prisoners are a vulnerable group who, compared with the general population, experience poorer health outcomes. However, there is a dearth of research quantifying the prevalence of non-communicable diseases (NCDs) among prisoner populations. Aim: To explore both the prevalence of NCDs and their risk factors. Design & setting: A cross-sectional survey was undertaken that was compared with clinical records in two male prisons in the north of England. Method: Self-report surveys were completed by 199 prisoners to assess sociodemographic characteristics, general health, NCD prevalence, and risk factor prevalence. Data were checked against that retrieved from prison clinical records. Results: It was found that 46% reported at least one NCD and 26% reported at least one physical health NCD. The most common self-reported NCD was 'anxiety and depression' (34%), followed by 'respiratory disease' (17%), and 'hypertension' (10%). Having a physical health NCD was independently associated with increasing age or drug dependence. The level of agreement between clinical records and self-report ranged from 'fair' for alcohol dependence (kappa 0.38; P<0.001) to 'very good' for diabetes (kappa 0.86; P<0.001). Compared with mainstream populations and despite high prevalence of risk factors for NCDs physical illness NCDs, with the exception of respiratory disease, are less common. However, poor mental health is more common. These differences are possibly owing to the younger average age of prison populations, since prevalence of risk factors was reported as high. Secondary data analysis of clinical records is a more methodologically robust way of monitoring trends in prisoner population disease prevalence. Anecdotally, prisoners have a high prevalence of modifiable risk factors for NCDs. However, there is a paucity of international prevalence studies. This data linkage study of both self-report and primary care records highlights both disease and risk factor prevalence in this vulnerable group, which place a high burden of care on primary care services.

Journal of Health Research, 2020

Purpose -The aim of present study was to integrate vital noncommunicable diseases (coronary artery disease, hypertension, diabetes mellitus and mental health disorders) into Prison-Based Active Health Services Provision (PAHSP). Design/methodology/approach -On Jan 1, 2018, there were 230,000 prisoners in Iran. Timely and systematic detection and diagnosis of chronic health conditions among this population are imperative. The collaboration between healthcare providers in prison and members of the multidisciplinary team of the healthcare community outside prison initiated an active health service provision approach for HIV and tuberculosis (TB). Guidelines for the control of HIV and TB in prison were piloted, and the finalized version was named "Prison-based Active Health Services Provision" (PAHSP), which has been scaled up in 16 of 260 Iranian prisons. Finding -The PAHSP approach emphasizes the importance of early identification of key symptoms and risk factors. This approach provides an opportunity for improved prevention and treatment, enabling prisoners identified at risk or those who have been diagnosed with a target disease to be followed up and receive the appropriate health care.

Public Health Behind Bars, 2007

Journal of Urban Health-bulletin of The New York Academy of Medicine, 2010

Given the rapid growth and aging of the US prison population in recent years, the disease profile and health care needs of inmates portend to have far-reaching public health implications. Although numerous studies have examined infectious disease prevalence and treatment in incarcerated populations, little is known about the prevalence of non-infectious chronic medical conditions in US prison populations. The purpose of this study was to estimate the prevalence of selected non-infectious chronic medical conditions among inmates in the Texas prison system. The study population consisted of the total census of inmates who were incarcerated in the Texas Department of Criminal Justice for any duration from September 1, 2006 through August 31, 2007 (N = 234,031). Information on medical diagnoses was obtained from a system-wide electronic medical record system. Overall crude prevalence estimates for the selected conditions were as follows: hypertension, 18.8%; asthma, 5.4%; diabetes, 4.2%; ischemic heart disease, 1.7%; chronic obstructive pulmonary disease, 0.96%; and cerebrovascular disease, 0.23%. Nearly one quarter (24.5%) of the study population had at least one of the selected conditions. Except for asthma, crude prevalence estimates of the selected conditions increased monotonically with age. Nearly two thirds (64.6%) of inmates who were ≥55 years of age had at least one of the selected conditions. Except for diabetes, crude prevalence estimates for the selected conditions were lower among Hispanic inmates than among non-Hispanic White inmates and African American inmates. Although age-standardized prevalence estimates for the selected conditions did not appear to exceed age-standardized estimates from the US general population, a large number of inmates were affected by one or more of these conditions. As the prison population continues to grow and to age, the burden of these conditions on correctional and community health care systems can be expected to increase.

Journal of Epidemiology & Community Health, 2005

Objectives: To describe the use of primary care services by a prisoner population so as to understand the great number of demands and therefore to plan services oriented to the specific needs of these patients. Design: Retrospective cohort study of a sample of prisoners' medical records. Setting: All Belgian prisons (n = 33). Patients: 513 patients over a total of 182 patient years, 3328 gneral practitioner (GP) contacts, 3655 reasons for encounter. Main results: Prisoners consulted the GP 17 times a year on average (95%CI 15 to 19.4). It is 3.8 times more than a demographically equivalent population in the community. The most common reasons for encounter were administrative procedures (22%) followed by psychological (13.1%), respiratory (12.9%), digestive (12.5%), musculoskeletal (12%), and skin problems (7.7%). Psychological reasons for consultations (n = 481) involved mainly (71%) feeling anxious, sleep disturbance, and prescription of psychoactive drugs. Many other visits concerned common problems that in other circumstances would not require any physician intervention. Conclusion: The most probable explanations for the substantial use of primary care in prison are the health status (many similarities noted between health problems at the admission and reasons for consultations during the prison term: mental health problems and health problems related to drug misuse), lack of access to informal health services (many contacts for common problems), prison rules (many consultations for administrative procedures), and mental health problems related to the difficulties of life in prison.