Corrections_Today_July_August_2020_Vol.82_No.4

Correctional Health Perspectives

increasing. It is now nearly 20% of the total population. The average age of inmates in the same prison system has gradually increased in the last six years from 33.75 years to 37.48 years old. While a four-year increase doesn’t seem that significant, it shows that the population is changing, and with that population change, the health care cost is increasing also. As a person ages, he or she tends to develop chronic conditions that leads to more outside hospitalizations, ad- ditional medication, laboratory tests, and medical procedures. The ACA Standards for Adult Correctional Institutions requires that all inmates receive a screening at intake for acute and chronic health conditions. When developing a chronic care program within correctional facili- ties, one of the first considerations is to determine when and who will screen for the chronic conditions. The ACA Standards for Adult Cor- rectional Institutions requires that all inmates receive a screening at intake for acute and chronic health conditions. Vital signs should also be completed at this time. The screening is to be completed by a health-trained or qualified health care personnel. Additionally, this is the time to have consents signed to request health records and to verify the prescriptions for reported

With these factors in mind, de- veloping a successful chronic care plan for incarcerated patients must be easily accessible and encourage self-management. The plan should focus on health promotion and well- being, and be team-based (Interior Health, 2019). High risk factors to address may include poor diet, a lack of physical activity, the use of tobacco, family history and risk fac- tors. Another factor to consider when developing a plan is where does he/ she spend their time? Where does he/ she work or go to school? Where does he/she spend their leisure time? Is the area smoky or dusty? What chemicals is he/she exposed to? Does he/she sit all day? Is the environment risky for accidents? The patient may need help leaving his/her comfort zone and managing a learned helplessness. It is difficult for patients that are in the community to break unhealthy habits, but those who are incarcerated and have repeatedly faced multiple barri- ers, may need encouragement to find a way to break through the barriers and be empowered. A growing population The number of people in the correctional facilities with chronic medical conditions has grown dra- matically over the last few years. Inmates tend to have chronic dis- eases at earlier ages than the general public. When the large number of aging baby boomers are considered, it begins to explain why correctional facilities are feeling the burden of conditions needing medical care. In the Nebraska prison system, the number of inmates who are 50 years or older has steadily been

medications. The information that is received at intake will then need to be reviewed by a practitioner. Within two weeks following intake, a comprehensive physical assessment is to be scheduled for the inmate. Lab results and any additional health information that has been gath- ered is to be reviewed and addressed. The chronic conditions identified dur- ing this process are to be placed onto a schedule appropriate for the diagnosis. The plan should include when labs are to be obtained, how often vital signs/weights are needed, and when to schedule a follow up appointment. Vaccinations should be reviewed and administered as indicated. Referrals are made to the appropriate depart- ments for optometry, dental, and behavioral health concerns. Specialist consults for certain chronic conditions may also be necessary. On the following page is a tem- plate that we developed in Nebraska as guidelines for providers to follow. The follow-up appointments may be changed per clinical judgment. The chart is divided by system and then by the disease process. Lab tests to be completed initially include Com- prehensive Metabolic Panel (CMP) with lipids and a complete blood count (CBC). Patients who are identi- fied with a thyroid dysfunction or a serious mental illness are to have a thyroid-stimulating hormone test also. Some mental health providers feel that this is an important criteria for treatment of underlying mental health disorders (Draw the TSH before starting a new psychiatric medica- tion in case the TSH is abnormal at a later date. It helps to determine if the medication caused the abnormality). Diabetic patients will have periodic

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