Journal of Correctional Health Care - April 2023 - 117

JUVENILE DETENTION AND PRIMARY CARE UTILIZATION
117
youth who had a documented diagnosis, 23% and 21.7%,
respectively, had a behavioral health-related diagnosis
or a medical health diagnosis. A demographic and health
status representation of those who accessed only PC, only
AC, both, or none is shown in Table 1.
One hundred thirty-five youth accessed PC before
their source encounter and 105 accessed PC after discharge
from the source encounter, representing an overall
22.2% decrease in PC access among study youth. Of
the youth accessing PC after discharge, 57 accessed PC
before their source admission and 48 did not have a history
of previous PC use. The results of a Fisher's exact
test show a significant association between PC access
before admission and PC access after discharge
(p< .001).
We investigated the relationship between PC access
after discharge from the source encounter and readmission.
Results of a multivariable logistic regression predicting
readmission show that youth who did access PC
were less likely to be readmitted than those who did
not access PC (adjusted odds ratio: 0.360; 95% confidence
interval: 0.217-0.594, p£ .0014), after controlling
Table 1. Demographic and Health Characteristics
of Individuals Accessing Primary Care, Acute Care, Both,
or None
All PC only AC only PC and AC None
Gender
Male
Female
Age (years)
£13
14
15
16
17
‡18
Race
White
Black
Hispanic
Asian
119 17
68
4
Other/unknown 37
Asthma
Diabetes
Acne/eczema
Obesity
Allergy
Behavioral
Total
55
10
42
442 46
6
5
40
Problem list diagnosisa
Medical (any)b 153 17
3
1
6
66 12
32
2
167 19
706 78
34
27
120
6
7
24
9
3
5
10
2
28
194
27
9
104
6
6
16
6
1
1
8
6
25
152
41
28
172
22
19
96
37
5
30
36
22
95
282
aDiagnosis totals may not equal the total individuals shown on the
bottom row as any youth may have multiple diagnoses.
bIndividual has any combination of asthma, diabetes, acne/eczema,
obesity, or allergy on the problem list.
AC, acute care; PC, primary care.
Table 2. Multivariable Logistic Regression Analyses Related
to Readmission (N= 706)
Readmission
Characteristics
PC after discharge
AC after discharge
Male (vs. female)
Age
Race (vs. White)
Black
Hispanic/Latino
Asian
Other/unknown
Medical diagnosis
Behavioral diagnosis
CI, confidence interval.
Adjusted odds ratio (95% CI)
0.360 (0.217-0.594)
0.697 (0.5462-1.051)
1.608 (1.090-2.370)
0.878 (0.779-0.990)
1.243 (0.656-2.354)
1.555 (1.003-2.408)
1.012 (0.471-2.196)
0.301 (0.110-0.821)
2.248 (1.501-3.366)
2.576 (1.721-3.854)
p
<.001
.085
.017
.034
.505
.048
.966
.019
<.001
<.001
543 58
163 20
40
1
88 10
152 21
172 22
191 18
63
6
150
44
9
31
39
47
52
16
105
47
14
24
32
36
33
13
230
52
16
23
60
67
88
28
Discussion
Consistent with previous research, this regional study
demonstrates that JJ-involved youth utilized AC more
often than PC, before and after admission to a juvenile
detention facility (Aalsma et al., 2017; Winkelman
et al., 2017). Youth saw decreased access to PC after
discharge from their source encounter, although some
did access PC after discharge who did not previously.
We observed that those who accessed PC were less likely
for AC visits, gender, age, race/ethnicity, and medical
and/or behavioral health diagnosis. AC access did not
reveal a significant relationship with readmission. Individuals
with a behavioral health diagnosis on the problem
list were 2.58 times more likely to be readmitted,
and those with a medical diagnosis were 2.25 times
more likely to be readmitted (see Table 2).
Both PC and AC were more likely to be accessed by
individuals with behavioral health diagnoses, after controlling
for gender, age, race/ethnicity, and medical diagnoses.
Additionally, youth identifying as male were less
likely to access PC than female youth. Results of a multivariable
logistic regression showing likelihood of
accessing PC or AC after discharge are shown in Table 3.
Readmissions were assessed at 30-day increments
after discharge from the source encounter or JJ admission.
The majority of youth experiencing readmission
were readmitted within 90 days of release from their
source encounter. The greatest increase in readmissions
occurred between days 30 and 60, followed by days 60
and 90, with increases slowing after day 90 (Fig. 1).
Readmissions occurred a median of 51 days after release.
For readmitted youth, PC was accessed a median of 41
days after release and AC a median of 48 days. Youth
who were not readmitted accessed PC and AC later
than those who were readmitted.
Journal of Correctional Health Care - April 2023

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