Care of Incarcerated Patients

 

The United States has the highest incarceration rate of any nation in the world. Approximately 870 of every 100,000 U.S. citizens are currently in jails or prisons. U.S. inmates are disproportionately young males, racial and ethnic minorities, and persons of low socioeconomic status. Incarcerated persons have high rates of psychiatric conditions, communicable diseases, substance use disorders, and chronic diseases. The U.S. Preventive Services Task Force recommends that all inmates be screened for human immunodeficiency virus infection, hepatitis C, syphilis, and latent tuberculosis infection, and that sexually active female inmates be screened for gonorrhea and chlamydia. Inmates should also be screened for psychiatric conditions and substance use disorders. Therapy should be continued for all chronic conditions when indicated. Inmates should be referred to community organizations for follow-up medical care and treatment of substance use disorders before they are released from detention facilities. A systematic approach to urgent, routine, and preventive care for persons in jails and prisons creates a healthier correctional environment and a healthier community after release.

Approximately 870 of every 100,000 U.S. adult citizens are in jail or prison, which represents the highest incarceration rate in the world.1 Incarcerated persons are guaranteed a right to health care by the 1976 U.S. Supreme Court decision Estelle v. Gamble.2 Although the type and quality of health care services for incarcerated persons differ because of variations in policies, budgets, and staffing across federal, state, and local jurisdictions, such care benefits individuals, their institutional communities, and their home communities after release.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Incarcerated adults and adolescents benefit from HIV screening.

A

19

Incarcerated or formerly incarcerated individuals should be screened for hepatitis C.

B

20

Incarcerated or formerly incarcerated individuals should be screened for syphilis infection.

A

21

Incarcerated persons are at increased risk of latent tuberculosis infection and should be screened.

B

22

Because of the high rates of psychiatric conditions and substance use disorders in incarcerated persons, inmates should be screened on entry to the facility with the Correctional Mental Health Screen or the Brief Jail Mental Health Screen.

C

29

Incarcerated persons 40 to 70 years of age should be screened for abnormal blood glucose levels if they are overweight or obese.

B

38


HIV = human immunodeficiency virus.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Incarcerated adults and adolescents benefit from HIV screening.

A

19

Incarcerated or formerly incarcerated individuals should be screened for hepatitis C.

B

20

Incarcerated or formerly incarcerated individuals should be screened for syphilis infection.

A

21

Incarcerated persons are at increased risk of latent tuberculosis infection and should be screened.

B

22

Because of the high rates of psychiatric conditions and substance use disorders in incarcerated persons, inmates should be screened on entry to the facility with the Correctional Mental Health Screen or the Brief Jail Mental Health Screen.

C

29

Incarcerated persons 40 to 70 years of age should be screened for abnormal blood glucose levels if they are overweight or obese.

B

38


HIV = human immunodeficiency virus.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

For the purposes of this article, the incarcerated population refers to persons held in local jails or under the jurisdiction of state or federal prisons. Jails, which are under county or municipal jurisdiction, house persons awaiting trial, sentencing, or transfer to another facility; those who have violated parole or probation; and those who have been sentenced to less than one year in custody. State and federal facilities house persons who have been sentenced to more than one year in custody. This article does not address juveniles in custody or adults in immigration detention facilities, territorial prisons, military facilities, or tribal justice facilities.

The Authors

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DAWN M. DAVIS, MD, MPH, is an assistant professor in the Department of Family and Community Medicine at Saint Louis (Mo.) University School of Medicine....

JENNIFER K. BELLO, MD, MS, is an assistant professor in the Department of Family and Community Medicine at Saint Louis University School of Medicine.

FRED ROTTNEK, MD, is a professor in the Department of Family and Community Medicine at Saint Louis University School of Medicine.

Address correspondence to Dawn M. Davis, MD, MPH, Saint Louis University School of Medicine, O'Donnell Hall, 2nd Floor, 1402 South Grand Blvd., St. Louis, MO 63104 (e-mail: dawn.davis@health.slu.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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