In Canada, 40% of people did not visit a family doctor after being released from prison

About 60 percent of people who were in Ontario's prison system were seen by a family doctor in the two years after being released from prison compared to 85 percent of people in the general population, according to a new study publishing on October 11 in Canadian Family Physician.

The researchers analyzed the experiences of people released from provincial prison in Ontario in 2010, and measured their health care visits two years prior to admission into prison and two years after release. Rates of being seen by a family doctor were only slightly higher after prison release than before admission to prison.

The study, co-authored by St. Michael's Hospital and ICES researchers and led by McMaster University's Dr. Fiona Kouyoumdjian, also found that those released from provincial prison were more likely to come from low income neighbourhoods and have a significantly higher prevalence of almost all health conditions examined, including asthma, diabetes, and mental health conditions.

"We found that people in prison were more likely to have chronic health conditions, yet they were less likely to be seen by a family doctor who could help them manage their health," said Dr. Tara Kiran, one of the authors of the study, who is also a family physician and an associate scientist with the Li Ka Shing Knowledge Institute of St. Michael's.

"Half of the people in our study were readmitted to prison within two years of release. It begs the question—how many of those readmissions could have been prevented if people had been connected with a family doctor who could support them to manage their depression or substance use?" said Dr. Kiran, who is also an adjunct scientist with the not-for-profit research institute ICES, where the Ontario data were analyzed.

The study also found that 20 percent of people released from prison accessed primary care through team-based care models, including community health centres and family health teams. The researchers noted that given the high prevalence of physical and mental health conditions in the prison release group, access to team-based care—including social workers—is especially important for that cohort.

Dr. Kiran said more research is needed to understand why people who are released from prison are so much less likely to access primary care. She said the study confirms that people who are in the prison system typically come from a background of poverty, and unfortunately that is likely a determinant of their trajectory in life.

"Society needs to do more to address the root causes of crime and imprisonment, and more structured programs are needed to link people discharged from prison with primary care."