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Prison health is public health: How a Personal Health Number is improving care for incarcerated clients

Imagine treating a patient for the first time without access to any of their previous medical records. That was the difficult task doctors and staff faced in all 10 correctional centres in B.C.—until now.
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​Starting April 2019, Correctional Health Services staff began using clients' BC Personal Health Number (PHN). A PHN is a unique lifetime identifier for health care. Prior to April, clients coming into B.C. Corrections were assigned a temporary PHN, used only while in custody. This made it difficult to ensure smooth care transitions as people moved in and out of correctional facilities. The new PHN process now enables health-care teams to better access a client's medical history and provide them with continuous care as they access health-care services within and beyond correctional services in the province.

"Prison health is important because most persons that are incarcerated will end up back in the communityupwards of 80-90 per cent of people," says Dr. Nader Sharifi, the medical director of Correctional Health Services. "So it became obvious very early that providing care in custody reflects on what happens in the community. For example, ensuring high quality STD (sexually transmitted diseases) testing and treatment in custody will prevent the spread of infectious disease in the community."

Unique health challenges

18,000 inmates enter correctional facilities each year in B.C. Their life expectancy is 15-20 years shorter than that of the general populationmostly due to preventable causes. With the province grappling with an opioid crisis, health-care teams say inmates are most at risk of overdosing in the first 30 days after they're released.

Della Kane works with the community transition team at Correctional Health Services. She supports clients with opioid-use disorders for approximately 30 days following their release, helping them connect with a community physician, fill prescriptions and access other recovery supports. 

"Often, the first month is when clients 'give up' and discontinue their medications due to systemic challenges on top of other stressors they are dealing with," says Kane. "Having the same PHN during and after incarceration will allow a client's health-care provider to look up their charts, and reduce their frustration and feelings of being overwhelmed."

People who leave custody are three times more likely to visit emergency departments and five times more likely to be admitted to hospital on an emergency basis. The system change to capture a PHN for everyone entering correctional facilities offers two big benefits: it allows health-care providers to measure and track clients' progress over time and it improves care continuity.

"People coming to jail are some of the most vulnerable in our society, and they need care and compassion," says Rebecca Hahn, the executive director of corporate and clinical support services. "Now we can ensure that when clients leave custody, their health information follows them so they can get the care they need. Clients are less likely to reoffend if you take good care of them. And they'll be more likely to return to the community and become healthy, productive members of society."

BC Mental Health & Substance Use Services
 
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