Medication Prescribing Observations in Care Transitions for Incarcerated Patients

Abstract

Background:

Typical strategies for obtaining medication lists may be suboptimal for incarcerated individuals due to unavailability of electronic transmission and verification methods, leading to potential delays and inaccuracies during care transitions. This study reviews disease states and medication lists at admission and discharge for incarcerated patients at a large academic medical center, hypothesizing that discrepancies in chronic disease diagnoses and medication lists exist during these care transitions.

Methods:

A retrospective, single-cohort analysis from January 1, 2017 to December 31, 2020, evaluated medication lists in incarcerated adults. Medication lists and chronic disease states, as defined by the Charlson comorbidity index, were assessed at 2 critical care transitions: on admission and at discharge. Pre-specified co-morbidities were selected to identify discrepancies involving missing or duplicate medications.

Results:

Of 557 eligible patients, 417 (75%) had active prescriptions on admission, averaging 8 medications per patient. Diagnostic discrepancies were infrequent upon admission and at discharge (3.9%), with conditions more often noted for the first time at discharge. In reviewing 309 patients with pre-specified co-morbidities, 55% exhibited at least 1 medication discrepancy, with an average of 1.65 co-morbidities reviewed per patient.

Conclusion:

The healthcare teams caring for incarcerated patients face unique challenges in medication management during hospital transitions. These medication lists are characterized by a high incidence of medication discrepancies despite a low incidence of diagnostic differences. To enhance care continuity and minimize risks, healthcare systems need to implement streamlined, standardized medication reconciliation processes and improve institutional policies to better support this vulnerable population.