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      Continuidad asistencial y terapéutica tras la excarcelación: un problema urgente que precisa soluciones. El modelo aplicado en las prisiones de Cataluña Translated title: Asistencial and therapeutic continuity after release from prison: an urgent problem that requires solutions. The model applied in Catalonian prisons

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          Abstract

          RESUMEN Los déficits en salud tras la excarcelación son habituales, incluso con mayor riesgo de muerte. En estos casos, la principal causa de muerte es el uso de heroína y de otros opioides, pero hay otras posibles causas, muchas de ellas potencialmente prevenibles. Los grupos más vulnerables al incremento de la morbimortalidad tras la excarcelación son los consumidores de drogas, los enfermos mentales y los internos extranjeros que proceden de países con pocos recursos económicos. Es urgente implementar intervenciones que optimicen el acceso a los dispositivos sanitarios después de la excarcelación, eviten interrupciones de la continuidad de la atención y del tratamiento prescrito en prisión, y reduzcan la morbimortalidad. Para ello, se precisa coordinar de forma efectiva la atención dentro y fuera de la prisión y aplicar medidas de apoyo. En este trabajo, se presenta el proyecto implementado en las prisiones de Cataluña, que ha utilizado el “enfermero de enlace” (EE) como figura clave del proceso, y el procedimiento interno y externo utilizado para facilitar el adecuado traspaso de información sanitaria y terapéutica, vincular a los pacientes excarcelados a los dispositivos sanitarios y asegurarse de que estos los reciben en el tiempo y la forma adecuados.

          Translated abstract

          ABSTRACT Deficits in health after being released are common, even with a higher risk of death. In these cases, the main cause of death is the use of heroin and other opioids, but there are more causes of death and most are potentially preventable. The most vulnerable groups to the increase of post-release morbidity and mortality are the drug users, the mentally ill and the foreign inmates from countries with few economic resources. It is urgent to implement interventions that optimize access to health devices after the prison release, avoid interruptions in the continuity of care and treatment prescribed in prison and reduce morbidity and mortality. To achieve this, it is necessary to coordinate the effective form of care inside and outside the prison and apply support measures. We present the project implemented in the prisons of Catalonia, which the “nurse of liaison” has used as a key figure in the process. We also present the internal and external procedure used to facilitate the transfer of sanitary and therapeutic information, to link released patients to health devices and to ensure that they are received in a timely and appropriate manner.

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          Mortality after prison release: opioid overdose and other causes of death, risk factors, and time trends from 1999 to 2009.

          Among former prisoners, a high rate of death has been documented in the early postrelease period, particularly from drug-related causes. Little is known about risk factors and trends in postrelease mortality in the past decade, especially given general population increases in overdose deaths from pharmaceutical opioids. To determine postrelease mortality between 1999 and 2009; cause-specific mortality rates; and whether sex, calendar year, and custody factors were risk factors for all-cause, overdose, and opioid-related deaths. Cohort study. Prison system of the Washington State Department of Corrections. 76 208 persons released from prison. Identities were linked probabilistically to the National Death Index to identify deaths and causes of death, and mortality rates were calculated. Cox proportional hazards regression estimated the effect of age, sex, race or ethnicity, whether the incarceration resulted from a violation of terms of the person's community supervision, length of incarceration, release type, and calendar year on the hazard ratio (HR) for death. The all-cause mortality rate was 737 per 100 000 person-years (95% CI, 708 to 766) (n = 2462 deaths). Opioids were involved in 14.8% of all deaths. Overdose was the leading cause of death (167 per 100 000 person-years [CI, 153 to 181]), and overdose deaths in former prisoners accounted for 8.3% of the overdose deaths among persons aged 15 to 84 years in Washington from 2000 to 2009. Women were at increased risk for overdose (HR, 1.38 [CI, 1.12 to 1.69]) and opioid-related deaths (HR, 1.39 [CI, 1.09 to 1.79]). The study was done in only 1 state. Innovation is needed to reduce the risk for overdose among former prisoners. National Institute on Drug Abuse and the Robert Wood Johnson Foundation.
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            Substance use disorders, psychiatric disorders, and mortality after release from prison: a nationwide longitudinal cohort study

            Summary Background High mortality rates have been reported in people released from prison compared with the general population. However, few studies have investigated potential risk factors associated with these high rates, especially psychiatric determinants. We aimed to investigate the association between psychiatric disorders and mortality in people released from prison in Sweden. Methods We studied all people who were imprisoned since Jan 1, 2000, and released before Dec 31, 2009, in Sweden for risks of all-cause and external-cause (accidents, suicide, homicide) mortality after prison release. We obtained data for substance use disorders and other psychiatric disorders, and criminological and sociodemographic factors from population-based registers. We calculated hazard ratios (HRs) by Cox regression, and then used them to calculate population attributable fractions for post-release mortality. To control for potential familial confounding, we compared individuals in the study with siblings who were also released from prison, but without psychiatric disorders. We tested whether any independent risk factors improved the prediction of mortality beyond age, sex, and criminal history. Findings We identified 47 326 individuals who were imprisoned. During a median follow-up time of 5·1 years (IQR 2·6–7·5), we recorded 2874 (6%) deaths after release from prison. The overall all-cause mortality rate was 1205 deaths per 100 000 person-years. Substance use disorders significantly increased the rate of all-cause mortality (alcohol use: adjusted HR 1·62, 95% CI 1·48–1·77; drug use: 1·67, 1·53–1·83), and the association was independent of sociodemographic, criminological, and familial factors. We identified no strong evidence that other psychiatric disorders increased mortality after we controlled for potential confounders. In people released from prison, 925 (34%) of all-cause deaths in men and 85 (50%) in women were potentially attributable to substance use disorders. Substance use disorders were also an independent determinant of external-cause mortality, with population attributable fraction estimates at 42% in men and 70% in women. Substance use disorders significantly improved the prediction of external-cause mortality, in addition to sociodemographic and criminological factors. Interpretation Interventions to address substance use disorders could substantially decrease the burden of excess mortality in people released from prison, but might need to be provided beyond the immediate period after release. Funding Wellcome Trust, Swedish Research Council, and the Swedish Research Council for Health, Working Life and Welfare.
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              The prevalence of mental disorders in Spanish prisons.

              The prevalence of mental disorders among prisoners has been researched in a few countries worldwide but never previously in Spain. Our aim was to estimate the lifetime and last month prevalence of mental disorders in a Spanish prison population. This is a descriptive, cross-sectional, epidemiological study of 707 male prisoners. Sociodemographic, clinical and offending data were collected by interviewers. Offending data were confirmed using penitentiary records. Mental disorders were assessed with the clinical version of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Axis I Disorders, and personality disorders were assessed through the Spanish version of the International Personality Disorders Examination. The lifetime prevalence of mental disorder was 84.4%. Substance use disorder (abuse and dependence) was the most frequent disorder (76.2%) followed by anxiety disorder (45.3%), mood disorder (41%) and psychotic disorder (10.7%). The period (last month) prevalence of any mental disorder was 41.2%. Anxiety disorder was the most prevalent (23.3%) followed by substance use disorder (abuse and dependence; 17.5%), mood disorder (14.9%) and psychotic disorder (4.2%). Although period prevalence figures, which are those generally provided in research into rates of mental disorder among prisoners, are useful for planning improvements to services within prisons, the fact that almost all of these men had a lifetime prevalence of at least one mental disorder suggests a much wider need for improving services, including community services, for this group. Copyright © 2011 John Wiley & Sons, Ltd.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                sanipe
                Revista Española de Sanidad Penitenciaria
                Rev. esp. sanid. penit.
                Sociedad Española de Sanidad Penitenciaria (Barcelona, Barcelona, Spain )
                1575-0620
                2013-6463
                2019
                : 21
                : 3
                : 163-170
                Affiliations
                [1] orgnameInstitut Català de la Salut orgdiv1Programa de Salut Penitenciària Spain
                Article
                S1575-06202019000300163 S1575-0620(19)02100300163
                6d3bfb4a-1283-44a3-ab5f-3693af5ad971

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 18 June 2019
                : 15 May 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 8
                Product

                SciELO Spain

                Categories
                Artículos Especiales

                nurse-patient relations,morbidity,mortality,prisons,mortalidad,morbilidad,relaciones enfermero-paciente,gestión en salud,prisiones,health management

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