Research highlights medication adherence challenges for former prisoners

Research highlights medication adherence challenges for former prisoners

Laura Dague and a team of other health researchers found that one particular scenario was always studying two years of data in prison inmates. This scenario included the days when an inmate is released and returns to his or her community. A significant number were published with chronic health problems and immediately enrolled in government-subsidized health care - only to stop taking their medications.

Why should they stop taking free (or almost free) medications? And do former prisoners have proper access to care when they return to their communities? These questions are raised by a new study conducted by Dague, a Ph.D. and professor at the Bush School of Government and Public Service.

People taking their medications is important to themselves and their communities. “

Laura Dague, Ph.D., Professor, the Bush School of Government and Public Service

The study was published in Jama Network Open, one of the top medical journals. Dague and her colleagues identified several trends. Most striking is the tendency for former inmates to abandon medication for a chronic condition, even when the cost is covered by Medicaid, the federal insurance program for low-income people. The researchers found this trend particularly striking because other studies have shown that Medicaid increases access to health care for people who were previously incarcerated. The new study suggests that insurance alone may not be enough.

Dague and her colleagues are not suggesting policy changes to address their findings. But she said the findings suggest new Medicaid policies to guide former inmates as they reenter their communities, including policies already encouraged under the Federal Support Act, "could be really impactful."

Two sources combined for a bigger picture

Dague and her colleagues focused their study on Wisconsin. They chose the state in part because it represents an unusually thorough effort in tracking inmate health data and making that data available to researchers in collaboration with the University of Wisconsin Institute on Poverty. (Dague also has an affiliation with the institute, where she is a colleague of her co-lead author Marguerite Burns, Ph.D.) Dague, Burns and their colleagues combine Wisconsin Department of Corrections information with medical data to trace inmates' medical histories from prison back to their communities.

The research team tracked all adults released from one of the state's correctional facilities from April 2015 to June 2017. That was 12,960 people, a population 90% male but racially diverse, from teenagers to seniors.

Researchers were particularly interested in the 4,302 people who took a chronic disease medication within three months of release and were enrolled in Medicaid immediately after release. People who continue to take medication and theoretically had easy access to it, in other words.

Only half of them seem to continue taking their medication.

The researchers reached this conclusion through Medicaid data that showed that only 51.7% filled their prescriptions, even though they all left prison with a prescription in hand.

Researchers also tracked how many former prisoners visited a doctor within six months of release. Access to a health care provider and/or willingness to visit one was an important predictor of former inmates' health. Those who saw a doctor were far more likely - 40 percentage points more likely - to fill their prescriptions. And you probably continue to take medications to help you stay healthy.

“These are people with heart disease, diabetes, anxiety and serious mental illness,” Dague said. She and her colleagues identified a total of 25 medication lessons for chronic illnesses, and those who took them, "Don't just stop needing medication because they got out of prison."

The study does not address why they stopped taking their medication. Nor does it assume that the picture in Wisconsin accurately reflects that elsewhere in the country. However, the findings suggest that similar issues exist elsewhere and should be addressed, Dague said.

Recently incarcerated people tend to have little, if any, income because they rarely have a job upon release. When a former inmate cannot afford his care and suffers a catastrophic health problem such as an emergency room visit, the costs are often socialized: spread among people who use the health care system or the taxable public. Many studies have shown that simple preventative steps - e.g. B. taking prescribed medications – can reduce such system-wide costs.

“We know that the health of inmates and their health after release are generally worse than demographically similar people,” Dague said, who have not been incarcerated. “This obviously has consequences for the individuals themselves, but also for their communities: more emergency responses, ambulance rides, emergency visits and other costs.”

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