Intersection of Structural Conditions that Contribute to Healthcare Access After Release from Prison: Qualitative Findings from the SCHARP Study.

BACKGROUND

People re-entering the community after prison face poor health outcomes and challenges accessing care. Structural conditions in healthcare systems may contribute to these problems.

OBJECTIVE

Understanding how multi-level conditions intersect and potentially compound one another to impact care delivered to patients recently released from prison.

DESIGN

Qualitative content analysis.

PARTICIPANTS

Participants were 17 healthcare leaders, 27 clinicians, 25 frontline staff, and 20 community members (n = 89). Sixteen community members had lived experience with incarceration; clinicians and frontline staff were in behavioral health, primary care, and emergency medicine.

MAIN MEASURES, OR APPROACH: We used interview guides that incorporated a conceptual model linking organizational structural conditions to health outcomes. We coded interview transcripts with deductive and inductive codes and analyzed them using qualitative content analysis.

KEY

RESULTS

People recently released from prison experience limits to accessing primary care. Findings revealed interrelated themes at the patient, healthcare, and prison system levels. Patients released from prison have heightened social needs (e.g., lack of financial resources or transportation), which significantly impact their ability to seek care and experiences with care. Patients' lack of skills to navigate the healthcare system and healthcare staff's lack of specialized training and experience, and healthcare system unavailability of patient information and medical history, can all contribute to gaps or difficulties for people getting care. Potential solutions identified include increasing access to primary care, support for insurance enrollment, availability of a primary care appointment upon release, access to medical clinics specialized in transition from incarceration or peer navigators, and better partnership between the Department of Corrections and healthcare systems.

CONCLUSIONS

To improve the health of persons recently released from prison, solutions need to address structural conditions in both healthcare and society. Solutions also require collaboration between and within healthcare systems, policy makers, and community organizations.