To the Editor: Dr Baillargeon and colleagues1 offered compelling evidence of the poor continuity of care for individuals with human immunodeficiency virus (HIV)/AIDS transitioning to community-based health care following release from prison. This study documented discontinuity in antiretroviral therapy, but many other chronic medical conditions are affected by poor transitions of care, including diabetes, asthma, and mental illness. Disenrollment of inmates from Medicaid, Medicare, and veterans' benefits during incarceration means that even those eligible for such benefits face substantial lag time in re-enrollment at release. Former inmates may resort to costly health care utilization to have basic medical needs met,2 resulting in inappropriate use of scarce public resources for health care. Discharge planning through the AIDS Drug Assistance Program may help reduce discontinuities in prescription drug treatment for individuals with HIV/AIDS, but for most inmates with chronic disease, such programs are unavailable. Interruptions in care can result in increased recidivism, medicolegal consequences, and mortality.3 - 5
Gaps in medical care often result from boundaries between publicly funded health care delivery systems, including jails, prisons, public health systems, universities, and the Veterans Administration. Investment in preventive care in one setting may not be rewarded by cost savings in the same setting. The lack of integration of medical care between different publicly funded delivery systems affects individuals across the spectrum of criminal justice involvement, including parole and probation. Prisons are not mandated to provide health care for individuals under correctional supervision in the community, but these individuals are sometimes denied access to care in the community because of their legal status. A lack of integration among different public systems thwarts efforts to improve transitions in care from prisons to communities, to reduce adverse outcomes, and to lower costs.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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