Rural substance use treatment centers in the United States: an assessment of treatment quality by location
Rural substance use treatment centers in the United States: an assessment of treatment quality by location
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DOI：
10.3109/00952990.2015.1059842
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发表时间：
2015-01-01
影响因子：
2.7
通讯作者：
Roman, Paul M.
中科院分区：
文献类型：
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作者：
Edmond, Mary Bond;Aletraris, Lydia;Roman, Paul M.
背景：虽然以前的研究增加了对农村居民独特健康挑战的理解，但在农村地区提供物质使用障碍（SUD）治疗方面仍有很多需要了解的地方。一个关键问题是农村和城市治疗中心在结构资源和护理质量上的差异。目的：研究农村和城市中心治疗质量的差异，并确定治疗质量的差异是否与中心的结构资源有关。方法：利用两家具有代表性的SUD治疗中心（n = 591）的联合数据，采用一系列多元回归分析中心乡村性与结构特征、治疗质量等各项指标的相关性。进一步研究了结构特征与处理质量指标之间的交互效应。结果：我们发现农村和城市治疗中心之间存在结构和质量差异。农村中心很少有机会接触到受过高等教育的咨询师，更有可能是非营利性的，依赖公共资金，提供的综合服务较少，专业治疗选择也较少。我们的研究结果还表明，农村中心不太可能将丁丙诺啡作为其治疗的一部分，但更有可能雇用护理人员并为青少年提供专门的治疗。农村中心的医生访问的背景中心农村和更有限的提供包络服务之间的联系。结论：我们的研究结果表明，城市和农村中心的治疗质量存在复杂的差异，这取决于资源的可用性。
Background: While previous research has added to the understanding of rural residents' unique health challenges, much remains to be learned about the provision of substance use disorder (SUD) treatment in rural areas. A key question is difference in structural resources and quality of care between rural and urban treatment centers. Objective: To examine differences in treatment quality in rural and urban centers and to determine if differences in treatment quality are contextualized by centers' structural resources. Methods: Utilizing combined data from two representative samples of SUD treatment centers (n = 591), we used a series of multivariate regressions to analyze the association between center rurality and various indicators of structural characteristics and treatment quality. Interaction effects were further examined between structural characteristics and treatment quality indicators. Results: We found that structural and quality differences between rural and urban treatment centers were present. Rural centers had reduced access to highly educated counselors, were more likely to be non-profit and dependent on public funding, offered fewer wraparound services, and had less diverse specialized treatment options. Our results also indicated that rural centers were less likely to prescribe buprenorphine as part of their treatment but were more likely to employ nursing staff and offer specialized treatment for adolescents. Rural center access to a physician contextualized the association between center rurality and the more limited provision of wraparound services. Conclusion: Our findings suggest that treatment quality differs between urban and rural centers in complex ways that are subject to resource availability.