Identification of health care problems in a county jail

The health care needs of prisoners often are not systematically addressed. To evaluate the ability of a questionnaire, that is administered at the time of arrest, to identify inmates' medical problems and to predict subsequent use of care, we reviewed and analyzed medical records and questionnaires for 594 individuals incarcerated in a county jail. Only 54% of subjects had a completed questionnaire filed in a medical record; the questionnaire identified only 48% of persons who eventually sought care for such major problems as drug and alcohol abuse and cardiopulmonary disease. No question screened for psychiatric problems, even though five percent of subjects were diagnosed as having major psychiatric disorders during their incarcerations. On the other hand, many items addressed problems that were far less common. Uniform screening of prison populations may be effective if conducted with greater rigor and better instruments than were employed in the institution studied. Health care for inmates might be served better by universal screening and follow-up, targeted to such important problems as drug and alcohol abuse and psychiatric disorders.