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Attachment to primary care and team-based primary care: retrospective cohort study of people who experienced imprisonment in Ontario

Kouyoumdjian F, Kim M, Kiran T, Cheng S, Fung K, Orkin A, Kendall CE, Green S, Matheson FI, Kiefer L. Can Fam Physician. 2019; 65(10):e433-42. Epub 2019 Oct 11.


Objective — To examine attachment to primary care and team-based primary care in the community for people who experienced imprisonment in Ontario, and to compare these attachment data with data for the general population.

Design — Population-based retrospective cohort study.

Setting — Ontario.

Participants — All persons released from provincial prison in Ontario to the community in 2010 who were linked with provincial health administrative data, and an age- and sex-matched general population group.

Main Outcome Measures — Primary care attachment and team-based primary care attachment in the 2 years before admission to provincial prison (baseline) and in the 2 years after release in 2010 (follow-up) for the prison release group, and for the corresponding periods for the general population group.

Results — People in the prison release group (n = 48 861) were less likely to be attached to primary care compared with the age- and sex-matched general population group (n = 195 444), at 58.9% versus 84.1% at baseline (P < .001) and 63.0% versus 84.4% during follow-up (P < .001), respectively. The difference in attachment to team-based primary care was small in magnitude but statistically significant, at 14.4% versus 16.1% at baseline (P < .001) and 19.9% versus 21.6% during follow-up (P < .001), respectively.

Conclusion — People who experience imprisonment have lower primary care attachment compared with the general population. Efforts should be made to understand barriers and to facilitate access to high-quality primary care for this population, including through initiatives to link people while in prison with primary care in the community.

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