DEFERRAL OF ROUTINE CARE IN THE CALIFORNIA STATE PRISON POPULATION DURING THE COVID-19 PANDEMIC

ABSTRACT

BACKGROUND: The COVID-19 pandemic has diverted health care resources from the management of chronic diseases toward acute care, with potential long-term consequences, especially among vulnerable populations. Incarcerated populations bear a higher chronic disease burden than the general community, while simultaneously experiencing COVID-19 outbreaks of higher acuity and associated mortality. The extent to which COVID-19 disrupted routine medical care within prison health systems has not been fully characterized. METHODS: We analyzed data from the California Department of Corrections and Rehabilitation (CDCR) for each California state prison (N=35) by month describing the delivery of medical care from January 1, 2019, to July 31, 2021. These data included quality measures describing the timeliness of clinical services for preventive care and chronic disease management, grouped by the CDCR into three categories (diagnostic, general medical, and specialty care). Statewide mean rates for each measure were weighted by prison population. Comparing these measures with prison-level COVID-19 incidence data from the CDCR for this period, we conducted a descriptive analysis of trends in the timely delivery of medical care in the CDCR during the COVID-19 pandemic relative to a pre-pandemic baseline period (2019). RESULTS: Populations housed within CDCR facilities experienced an initial wave of COVID-19 cases between June and October 2020, followed by a larger wave between November 2020 and February 2021. During the second wave, timely delivery of non-urgent PCP services decreased from a baseline of 91.7% to 79.0% (mean difference -12.7%;95% [CI], -16.6 to -8.9). Timely delivery of non-urgent specialty services decreased from a baseline of 87.3% to 56.4% (mean difference -31.0%;95% [CI], -36.8 to -25.1). Smaller, but statistically significant declines were seen in the timeliness of urgent PCP services (mean difference -7.8%;95% [CI], -10.2 to -5.5) and high priority specialty services (mean difference -13.8%;95% [CI], -17.1 to -10.4). CONCLUSIONS: The population incarcerated in California state prisons experienced sustained, significant delays in receipt of routine care during the COVID-19 pandemic. In comparison, outpatient visit volume in nonincarcerated populations nationwide decreased by up to 58% during the initial wave, but volumes recovered rapidly with a shift toward virtual care and remained stable despite the second wave. Policies to bolster prison health care systems during the ongoing pandemic will be critical for a stable recovery in access to chronic disease management and preventive care for this vulnerable population.