African-American injection drug users: association between pre-treatment services and entry into and completion of detoxification

Enhancing pathways to care for black and minority ethnic populations: a systematic review

BACKGROUND

Improving pathways to care is an important part of UK Government policy on delivering equitable treatment for black and minority ethnic (BME) patients. However, there is little guidance on how this can be achieved. This systematic review aimed to evaluate research studies reporting initiatives to enhance pathways to mental health care for BME groups.

METHODS

A review of published English language literature of studies reporting an evaluated intervention that aimed to enhance care pathways for BME communities or that achieved this as a by-product. Data extracted included the type of pathway improved, samples characteristics, type of intervention and outcome.

RESULTS

Six studies met inclusion criteria. In only one was the initiative UK based. There was evidence that interventions led to three types of pathways change; accelerated transit through care pathways, removal of adverse pathways, and the addition of a beneficial pathway. Ethnic matching promoted desired pathways in many groups but not African Americans, managed care improved equity a pre-treatment service improved access to detoxification and an education leaflet increased recovery.

CONCLUSION

Only a small number of papers satisfied the review criteria. Consequently, there is currently a dearth of information on which to build evidence-based guidance for service development. Evidence that is available is mainly not from the UK and hence needs to be treated with caution.

Correlates of pre-treatment drop-out among persons with marijuana dependence

AIMS

Our objective was to identify client characteristics and other factors associated with pre-treatment drop-out by people with marijuana dependence.

DESIGN AND PARTICIPANTS

Data from the Marijuana Treatment Project's screening assessment were used to examine correlates of pre-treatment drop-out. Information from all eligible study participants (n = 813) (i.e. those who were interested in receiving treatment for their marijuana dependence and were determined to be eligible for the randomized treatment efficacy trial) was used to examine differences between the 450 participants who initiated treatment (by enrolling in the trial) and the 363 individuals who declined enrollment.

SETTING

The study was conducted at three community-based outpatient treatment facilities in Farmington, CT, Seattle, WA and Miami, FL.

MEASUREMENTS

The information gathered in the screening interview included demographic characteristics, residential stability variables, employment and education history and referral source. Substance use variables included the number of days and the number of times per day marijuana was used, self-perceived dependence on marijuana, alcohol or other drugs, other drug use history and current treatment (i.e. substance abuse, medical, psychiatric) situation.

FINDINGS

Stepwise logistic regression was conducted to confirm variables associated with treatment initiation in bivariate analyses. Pre-treatment drop-out was associated with being younger, unmarried, unemployed, less educated and Asian American or Native American. It was also associated with self-perceived dependence on marijuana and use of other drugs.

CONCLUSIONS

By recognizing demographic and substance use factors that may serve as barriers for individuals accessing treatment for marijuana dependence, clinicians may target clients with these characteristics proactively to encourage treatment initiation and subsequent attendance.