Chronic Disease Management and Healthcare Utilization Among the Justice Involved Population

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2021

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Abstract

The criminal justice healthcare system has the potential to impact millions of individuals annually. There are more than 2.3 million individuals in a prison or jail at any given time. Not accounting for individuals that have been released from a correctional setting back into the community, under community supervision, which account for 4.5 million individuals. Individuals with a history of justice-involvement have higher prevalence of chronic diseases and often seek healthcare in high-cost area such as the emergency room. Furthermore, this population face unique challenges related to socioeconomic needs, such as securing housing and employment. Yet, limited empirical evidence explores chronic noncommunicable diseases (NCDs) or factors that impact how one manages their chronic NCD after incarceration using a representative sample. Therefore, this dissertation uses a cross-sectional, descriptive, correlational study using the 2018 National Survey of Drug Use and Health to estimate the rates for the five chronic NCDs (heart conditions, hypertension, diabetes, asthma, and cancer) and the rates of individuals with a history of a chronic NCD. In addition, this dissertation has examined outpatient healthcare utilization among adults in the community supervised population (CSP) relative to the adults in the non-CSP.This dissertation includes a scoping review of literature in Chapter 2 that examine current practices of care and interventions use to improve the management of chronic diseases within a correctional setting. As well, as a broad scope of the current state of the evidence regarding chronic disease management within this population. Chapter 3 aims to describe the rates of chronic NCDs, history of having a chronic NCD, and outpatient utilization in the CSP relative to the non-CSP. In addition, Chapter 3, explores the differences in rates of chronic NCDs, history of having a chronic NCD, and outpatient utilization among the CSP (probation, parolee, and probation and parole). Chapter 4 dives deeper within the CSP to identify individual characteristics, socioeconomic characteristics, and clinical characteristics that are associated with chronic NCDs, history of having a chronic NCD, and outpatient utilization. Chapter 5 synthesized findings within the context of the current literature and produces future directions in research, policy, and practice that the results may impact to improve the management of chronic NCDs among the justice-involved population. Furthermore, the limitations to this dissertation are addressed within the context of the study. Management of chronic diseases among the justice-involved population is critical to ensuring improved health outcomes and reducing the burden of public healthcare systems. Identifying and describing the population characteristics of the CSP is foundational in developing targeted interventions in policy and practice with the goals to achieve optimal health outcomes among the justice involved population.

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Calhoun, Nicole D (2021). Chronic Disease Management and Healthcare Utilization Among the Justice Involved Population. Dissertation, Duke University. Retrieved from https://hdl.handle.net/10161/23098.

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