Racial Disparities in Access to Appropriate Alcohol Treatment Services

说明(申请人提供)：本研究的主要目的是评估在获得适当的酒精治疗服务方面的种族/族裔差异，找出造成这些差异的因素，并更好地了解这些差异如何影响各族裔群体和随着时间的推移酒精问题的缓解。国民待遇普查和一般人口调查以前的调查结果提供了一个有限的、不一致的图景，说明各种族/族裔群体在获得和利用治疗方面的差异。然而，越来越多的迹象表明，向少数群体提供的护理往往与他们的需求状况不相适应。鉴于某些种族/族裔群体与酒精有关的发病率和死亡率高得不成比例，必须评估在获得适当治疗方面的差距的大小和潜在因素。拟议的研究将卫生服务研究的见解引入到这些问题上，将寻求治疗的模式调整为对反映所接受治疗的适当性和终点缓解的多个结果的纵向分析。该项目基于NIAAA的全国酒精及相关疾病流行病学调查(NESARC)的二级分析，NESARC是2001至2005年间进行的具有全国代表性的纵向调查。使用新技术对复杂的调查数据进行纵向分析，分析将从重要的协变量中分离种族/族裔的影响，如需求的严重程度、合并症和社会经济指标，并评估为什么在治疗利用方面存在差异的相互矛盾的解释。随着时间的推移，分析将记录和盘点酒精问题以及同时出现的药物和精神障碍的模式中种族/民族差异的程度。然后，在临床实践指南的指导下，分析将记录在接受与需求严重程度相关的适当治疗方面的种族/民族差异。因此，具体目标包括：(1)使用多种需求指标，描述酒精治疗服务需求的种族/族裔差异，以及需求随时间的持续情况；(2)评估未得到满足的服务需求中的种族/族裔差异的程度，特别强调服务在多大程度上符合种族/民族的需要；(3)研究未得到满足的需求和获得适当护理方面的种族/族裔差异如何由态度、后勤和结构性障碍来解释；以及(4)评估利用适当的治疗服务对长期缓解酒精问题方面的种族/族裔差异的影响。根据已公布的临床指南，这项研究调查了种族/民族群体对酒精服务的需求在多大程度上得到了适当的治疗服务满足。该项目进一步审查了可能有助于解释在适当治疗方面存在差异的因素，以及这些差异对从酒精问题中康复的影响。因此，这项研究将有助于为政策制定和治疗规划工作提供信息，以减少在提供酒精治疗服务方面的不平等，并评估这些不平等对美国不同种族/民族的酒精障碍负担的影响。

DESCRIPTION (provided by applicant): The main objectives of this study are to assess racial/ethnic disparities in access to appropriate alcohol treatment services, to identify factors that contribute to these disparities, and to better understand how these disparities impact remission of alcohol problems across ethnic groups and over time. Prior findings from national treatment censuses and general population surveys provide a limited, inconsistent picture of the variation in treatment access and utilization across racial/ethnic groups. However, there are growing indications that the care provided to minority groups tends to be inappropriate relative to their profiles of need. Given the disproportionately high rates of alcohol-related morbidity and mortality in some racial/ethnic groups, it is important to assess the magnitude of, and factors underlying, disparities in access to appropriate treatment. The proposed study brings insights from health services research to bear on these issues by adapting models of treatment-seeking to the longitudinal analysis of multiple outcomes that reflect both the appropriateness of treatment received, and end-point remission. The project is based on secondary analyses of the NIAAA's National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative longitudinal survey conducted between 2001 and 2005. Using new techniques for the longitudinal analysis of complex survey data, analyses will disentangle the effects of race/ethnicity from important covariates, such as severity of need, comorbidities, and socioeconomic indicators, and assess competing explanations for why there exist disparities in treatment utilization. Analyses will document and inventory the extent of racial/ethnic variation in the patterning of alcohol problems and co-occurring drug and psychiatric disorders over time. Then, informed by clinical practice guidelines, analyses will document racial/ethnic differences in the receipt of appropriate treatment in relation to the severity of need. The Specific Aims thus include: (1) to describe racial/ethnic variation in the need for alcohol treatment services, and the persistence of need over time, using multiple need indicators; (2) to assess the extent of racial/ethnic disparities in unmet need for services, with a particular emphasis on the degree to which services appropriately fit racial/ethnic profiles of need, (3) to examine how racial/ethnic disparities in unmet need and access to appropriate care are explained by attitudinal, logistical, and structural barriers to treatment, and (4) to assess the impact of the utilization of appropriate treatment services on racial/ethnic differences in the remission of alcohol problems over time. Relevance This study investigates the degree to which racial/ethnic groups' needs for alcohol services are met with appropriate treatment services, based on published clinical guidelines. The project further examines factors that may help to explain disparities in appropriate treatment access, and the impact that these disparities have on recovery from alcohol problems. This study will thus help to inform policymaking and treatment planning efforts to reduce inequities in the delivery of alcohol treatment services, and to assess the impact of these inequities on the burden of alcohol disorders across different racial/ethnic groups in America.