A linked administrative data study of continuity of care for patients involved with Alberta provincial corrections

Background. Alberta has been a leader in correctional healthcare delivery, providing health services through the Ministry of Health since 2010, and more recently through the Ministry of Mental Health and Addiction. People with incarceration experience tend to have complex health needs spanning mental health, substance use, and physical health. Though continuity has recently become a focus in correctional healthcare, details of patients’ health needs, available services, and continuity of care on release are not widely available outside of Correctional Health Services. Objectives. 1) Characterize people receiving physician care in Alberta corrections between April 1, 2017 and March 31, 2020. 2) Describe fee-for-service healthcare billings from Alberta provincial corrections. 3) Identify factors associated with continuity and fragmentation of care. Methods. Using administrative health data, we identified patients receiving healthcare in Alberta provincial remand and correctional facilities. Multiple logistic regression was used to model predisposing, enabling, need, and behaviour factors associated with adequate continuity and high fragmentation of care. Results were interpreted in collaboration with community partners representing various municipal and provincial organizations. Results. 8,301 patients were identified. Linkage to a primary care physician was the top predictor of adequate continuity and low fragmentation of care. Rural patients were more likely to have adequate continuity. Homelessness and OAT were related to low continuity and high fragmentation. Physical health multimorbidity was related to adequate continuity among patients linked to primary care, and low continuity otherwise. Implications. Administrative data have potential to inform improvements to the care continuum if interpreted with nuance and context. As correctional healthcare shifts its focus to release planning, further work on continuity of care for this population is warranted to improve outcomes for patients upon release.