Accessibility of addiction treatment: Results from a national survey of outpatient substance abuse treatment organizations
Accessibility of addiction treatment: Results from a national survey of outpatient substance abuse treatment organizations
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DOI：
10.1111/1475-6773.00151
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发表时间：
2003-06-01
影响因子：
3.4
通讯作者：
D'Aunno, TA
中科院分区：
文献类型：
--
作者：
Friedmann, PD;Lemon, SC;D'Aunno, TA
目标.本研究探讨了与门诊成瘾治疗的可及性相关的组织层面特征。在1990年，1995年和2000年，对来自美国门诊药物滥用治疗单位的全国代表性小组的项目主任和临床主管进行了调查。可及性是从临床监督员的报告中衡量的，包括治疗机构是否提供“按需治疗”（治疗进入的平均等待时间为48小时或更短），以及该计划是否拒绝了任何患者。在多变量logistic模型中，从1990年到2000年，“按需治疗”的提供增加了两倍（OR，1.95; 95%CI，1.5 - 2.6），而拒绝患者的报告无显著减少。私营营利性单位提供“按需治疗”的可能性是公共项目的两倍（OR，2.2; 95%CI，1.3至3.6），但拒绝患者的可能性是公共项目的七倍（OR，7.4; 95%CI，3.2至17.5）。相反，为更贫困人口服务的单位不太可能提供“按需治疗”或拒绝病人。美沙酮维持治疗项目也不太可能提供“按需治疗”（OR，0.65; 95%CI，0.42 - 0.99），但更可能拒绝患者（OR，2.4; 95%CI，1.4 - 4.3）。虽然在整个1990年代，及时提供成瘾治疗似乎有所增加，但在照顾贫困患者的方案和美沙酮维持方案中，可及性问题仍然存在。
Objectives. This study examined organization-level characteristics associated with the accessibility of outpatient addiction treatment.Methods. Program directors and clinical supervisors from a nationally representative panel of outpatient substance abuse treatment units in the United States were surveyed in 1990, 1995, and 2000. Accessibility was measured from clinical supervisors' reports of whether the treatment organization provided "treatment on demand" (an average wait time of 48 hours or less for treatment entry), and of whether the program turned away any patients.Results. In multivariable logistic models, provision of "treatment on demand" increased two-fold from 1990 to 2000 (OR, 1.95; 95 percent CI, 1.5 to 2.6), while reports of turning patients away decreased nonsignificantly. Private for-profit units were twice as likely to provide "treatment on demand" (OR, 2.2; 95 percent CI, 1.3 to 3.6), but seven times more likely to turn patients away (OR, 7.4; 95 percent CI, 3.2 to 17.5) than public programs. Conversely, units that served more indigent populations were less likely to provide "treatment on demand" or to turn patients away. Methadone maintenance programs were also less likely to offer "treatment on demand" (OR,.65; 95 percent CI,.42 to.99), but more likely to turn patients away (OR, 2.4; 95 percent CI, 1.4 to 4.3).Conclusions. Although the provision of timely addiction treatment appears to have increased throughout the 1990s, accessibility problems persist in programs that care for indigent patients and in methadone maintenance programs.