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Early primary care physician contact and health service utilisation in a large sample of recently released ex-prisoners in Australia: prospective cohort study
  1. Jesse T Young1,2,3,
  2. Diane Arnold-Reed1,4,
  3. David Preen1,
  4. Max Bulsara1,5,
  5. Nick Lennox6,
  6. Stuart A Kinner2,7,8,9
  1. 1Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
  2. 2Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
  3. 3National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
  4. 4General Practice and Primary Health Care Research, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
  5. 5Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
  6. 6Queensland Centre for Intellectual and Developmental Disability, School of Medicine, The University of Queensland, Mater Misericordiae Hospital, South Brisbane, Queensland, Australia
  7. 7School of Medicine, the University of Queensland, Herston, Queensland, Australia
  8. 8School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
  9. 9Murdoch Children's Research Institute, Parkville, Victoria, Australia
  1. Correspondence to Jesse Tyler Young; jesse.young{at}


Objective To describe the association between ex-prisoner primary care physician contact within 1 month of prison release and health service utilisation in the 6 months following release.

Design A cohort from the Passports study with a mean follow-up of 219 (±44) days postrelease. Associations were assessed using a multivariate Andersen-Gill model, controlling for a range of other factors.

Setting Face-to-face, baseline interviews were conducted in a sample of prisoners within 6 weeks of expected release from seven prisons in Queensland, Australia, from 2008 to 2010, with telephone follow-up interviews 1, 3 and 6 months postrelease.

Participants From an original population-based sample of 1325 sentenced adult (≥18 years) prisoners, 478 participants were excluded due to not being released from prison during follow-up (n=7, 0.5%), loss to follow-up (n=257, 19.4%), or lacking exposure data (n=214, 16.2%). A total of 847 (63.9%) participants were included in the analyses.

Exposure Primary care physician contact within 1 month of follow-up as a dichotomous measure.

Main outcome measures Adjusted time-to-event hazard rates for hospital, mental health, alcohol and other drug and subsequent primary care physician service utilisations assessed as multiple failure time-interval data.

Results Primary care physician contact prevalence within 1 month of follow-up was 46.5%. One-month primary care physician contact was positively associated with hospital (adjusted HR (AHR)=2.07; 95% CI 1.39 to 3.09), mental health (AHR=1.65; 95% CI 1.24 to 2.19), alcohol and other drug (AHR=1.48; 95% CI 1.15 to 1.90) and subsequent primary care physician service utilisation (AHR=1.47; 95% CI 1.26 to 1.72) over 6 months of follow-up.

Conclusions Engagement with primary care physician services soon after prison release increases health service utilisation during the critical community transition period for ex-prisoners.

Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12608000232336).


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