Continuum model proving successful in Northeast
Medical care is a means to community re-entry
HIV providers often are unable to reach a large population of HIV-infected people because many of those people have been in and out of prisons and jails and haven’t made the transition to community health care services.
While prison and jail systems vary greatly according to how they handle their HIV-infected and other chronically ill offenders, there are some good role models for systems that work with community groups and providers to offer a nearly seamless continuum of care. One such role model is the Hampden County Correctional Center in Ludlow, MA.
The local corrections system, which serves the Springfield, MA, area, has 1,800 inmates, including 90 to 100 inmates with HIV. Most of the people incarcerated in Hampden County are a great deal less healthy than the general public, says Tom Conklin, MD, director of health services.
"Seventy-five percent of our inmates here are addicted to nicotine; 80% are involved in drugs or substance abuse, and we have 40 cases of diabetes," Conklin says. "We have around 40 to 60 people with asthma, 50 people with hypertension, and 20 with heart disease and numerous new cases of sexually transmitted diseases [STDs]." Also, 30% of the jail’s inmates have hepatitis C.
The correctional center decided to invest money, including 10% of its general fund, to develop a public health model of care for both the inmates and the community. Conklin says. The center’s mission is to help inmates live healthier lives while in jail and once they are released. The center provides each inmate with a comprehensive assessment, prompt and effective treatment, education, prevention, and a continuity of care that links people back into the community.
Here’s how the program works:
• Comprehensive assessment: Each patient is tested for various STDs and liver function and is offered an HIV test. About 1,300 HIV tests were conducted last year. Most inmates agree to the test, Conklin says. "If you explain why the test is important, most people will say, Yes, I’d like to take that test.’"
All inmates receive a physical exam and tuberculosis screening test, and all women receive a pregnancy test and a pelvic exam with cultures and Pap smears.
• Prompt and effective treatment: Conklin says the jail system provides health care services according to the community’s standard of care.
"A couple of years ago, we interviewed 1,300 inmates and found out that 80% of them had never had any regular health care, and yet many were sick," Conklin says.
Because the inmates didn’t have doctors they would see on a regular basis, they typically went to the emergency room whenever they were sick. "That’s the most expensive form of health care, and it’s overutilized and crowded," he adds. "So we saw ourselves as an entry point for the health care system and showing inmates how to properly utilize that system and how not to improperly utilize the emergency rooms and urgent care centers."
Five registered nurses visit four jail pods each day, treating inmates according to 60 protocols.
"They take care of all the lumps and bumps and sore throats," Conklin says, adding that inmates don’t have to ask for help when they’re sick, the help comes to them.
This is markedly different from what some jails across the country are doing to help offset the high cost of providing health care to inmates, Conklin adds. "Some sheriff’s departments will give inmates a financial incentive to make a medical decision against themselves."
For example, one recent trend is for jails to charge inmates $5 to $10 to see a nurse and $3 to $5 for every new prescription or 30-day renewal.
"They say they don’t deny anybody who doesn’t have the funds to pay for it, but that’s only lip service," Conklin says. "The problem is that it weeds out both people who may unnecessarily go to the medical department and it weeds out people who have a major medical problem that should cause them to go to the medical department, such as the guy with a lump that later turns out to be a cancerous lesion."
Massachusetts’ jails are covered under the state’s AIDS Drugs Assistance Program (ADAP), while prisons are not covered. That means offenders can receive ADAP money for drugs while they are housed in the local jail, which saves the counties a great deal of money.
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