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UBC Theses and Dissertations

The impact of prison health policy : a multimethod study of the context and outcomes of the transfer of healthcare services in British Columbia’s provincial correctional facilities to the Ministry of Health McLeod, Katherine Elizabeth


Background: Effective prison healthcare governance is essential to addressing health inequities faced by people who experience incarceration. There is a global lack of evidence concerning current governance models or their impact. In 2017 British Columbia transferred responsibility for healthcare in provincial correctional facilities from a private for-profit contractor to the Ministry of Health. This dissertation work aimed to examine the effects of this transfer on healthcare providers, as well as the impact of early changes to discharge planning and use of opioid agonist therapy (OAT) on outcomes among people recently released. Methods: I analysed interviews with correctional healthcare leadership (n=8) using Interpretive Description methodology. Using linked administrative data for a sample of releases between January 1, 2015 – December 1, 2018, I employed recurrent event models to examine outcomes in the 30 days after release. Among all releases (n=16,809) I assessed use of community healthcare services and subsequent overdose. Among people with opioid use disorder (n=4,738) I examined expanded access to OAT in custody and overdose after release. Results: Qualitative analysis revealed that the transfer had a positive impact on job satisfaction among healthcare providers, the sense of meaning of their work and the quality of care they felt able to provide. Quantitative analyses identified significant effects of the transfer on health outcomes after release from custody. People released after the transfer were more likely to access community healthcare services; use of this healthcare was associated with having a healthcare-attended nonfatal overdose and reduced hazard of fatal overdose. A higher proportion of people released after the transfer received OAT in custody. Use of OAT was associated with a decreased hazard of nonfatal overdose after release, including among people who initiated a new episode of OAT in custody. Conclusions: The change of governance for healthcare services in provincial correctional facilities resulted in improvements in the quality and continuity of care, the work-life and wellbeing of healthcare providers, and health outcomes of people who experience incarceration. Integrating correctional facilities within community healthcare systems may help address health disparities for people and communities. Lessons learned in British Columbia provide valuable insights for other jurisdictions.

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