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Helminen EC, Cascalheira CJ, Shaw TJ, Zollweg S, Hughes TL, Scheer JR. A latent class analysis of tailored substance use treatment programs: Implications for treating syndemic conditions facing sexual and gender minority populations. Drug Alcohol Depend 2022; 238:109550. [PMID: 35820291 PMCID: PMC9444885 DOI: 10.1016/j.drugalcdep.2022.109550] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Syndemics (i.e., multiple, co-occurring, and synergistic conditions) contribute to elevated substance use among sexual and gender minority (SGM) people relative to heterosexual, cisgender people. Research suggests that syndemic-informed and SGM-tailored treatments are effective in substance use treatment among SGM people. However, few studies have examined 1) the proportion of substance use treatment facilities offering syndemic-informed, SGM-tailored treatment programming; and 2) the availability and accessibility of syndemic-informed, SGM-tailored treatment programs across the U.S. METHODS We used the 2020 National Survey of Substance Abuse Treatment Services (N-SSATS) dataset to perform a latent class analysis examining whether substance use treatment facilities' tailored treatment programs cluster together to form distinct classes indicating whether facilities offer syndemic-informed and SGM-tailored programming. We then used multinomial logistic regression to examine associations between class membership and facility availability and accessibility. RESULTS Analyses revealed four classes of substance use treatment facilities' tailored programs. Facilities with syndemic-informed and SGM-tailored treatment programs compared to facilities with no tailored programs were more likely to be in the Northeast compared to the Midwest and South; to offer payment assistance versus not offer payment assistance; and to be private, for-profit facilities versus public or non-profit facilities. CONCLUSIONS This study's findings identify the need for more facilities with syndemic-informed and SGM-tailored treatment, particularly in the Midwestern and Southern U.S. regions. Facilities offering syndemic-informed and SGM-tailored treatment might present accessibility barriers for low-income SGM people, as they were more likely to be private, for-profit facilities; however, they were more likely to offer payment assistance.
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Affiliation(s)
- Emily C Helminen
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Cory J Cascalheira
- Department of Psychology, Syracuse University, Syracuse, NY, USA; Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Thomas J Shaw
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Sarah Zollweg
- School of Nursing, Columbia University, New York, NY, USA
| | - Tonda L Hughes
- School of Nursing, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University, New York, NY, USA
| | - Jillian R Scheer
- Department of Psychology, Syracuse University, Syracuse, NY, USA.
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Cummings JR, Wen H, Ko M. Decline In Public Substance Use Disorder Treatment Centers Most Serious In Counties With High Shares Of Black Residents. Health Aff (Millwood) 2018; 35:1036-44. [PMID: 27269020 DOI: 10.1377/hlthaff.2015.1630] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Previous research has associated declines in health care resources such as hospitals and trauma centers with communities' racial composition. However, little is known about changes in the substance use disorder treatment infrastructure in recent years and the implications for black communities. We used data for the period 2002-10 from the National Survey of Substance Abuse Treatment Services to describe changes in the supply of public and private outpatient facilities for substance use disorder treatment, and to determine whether these trends had implications for the geographical availability of these facilities in counties with high percentages of black residents. During the study period the number of publicly owned facilities declined 17.2 percent, whereas the number of private for-profit facilities grew 19.1 percent. At baseline, counties with very high percentages of black residents (that is, more than one standard deviation above the mean) were more likely than counties with less than the mean percentage of black residents to be served by public facilities and were thus disproportionately affected by the overall decline in public facilities. Future research should examine the effect of expanding eligibility for Medicaid on the supply of substance use disorder treatment facilities across diverse communities.
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Affiliation(s)
- Janet R Cummings
- Janet R. Cummings is an associate professor in the Department of Health Policy and Management, Rollins School of Public Health, at Emory University, in Atlanta, Georgia
| | - Hefei Wen
- Hefei Wen is an assistant professor of health management and policy at the University of Kentucky, in Lexington
| | - Michelle Ko
- Michelle Ko is a research scientist at the Center for Health Policy Research, at the University of California, Los Angeles
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Nazareno J. Welfare State Replacements: Deinstitutionalization, Privatization and the Outsourcing to Immigrant Women Enterprise. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2018; 48:247-266. [PMID: 29473439 DOI: 10.1177/0020731418759876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The U.S. government has a long tradition of providing direct care services to many of its most vulnerable citizens through market-based solutions and subsidized private entities. The privatized welfare state has led to the continued displacement of some of our most disenfranchised groups in need of long-term care. Situated after the U.S. deinstitutionalization era, this is the first study to examine how immigrant Filipino women emerged as owners of de facto mental health care facilities that cater to the displaced, impoverished, severely mentally ill population. These immigrant women-owned businesses serve as welfare state replacements, overseeing the health and illness of these individuals by providing housing, custodial care, and medical services after the massive closure of state mental hospitals that occurred between 1955 and 1980. This study explains the onset of these businesses and the challenges that one immigrant group faces as owners, the meanings of care associated with their de facto mental health care enterprises, and the conditions under which they have operated for more than 40 years.
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Affiliation(s)
- Jennifer Nazareno
- 1 School of Public Health and Jonathan M. Nelson Center for Entrepreneurship, 6752 Brown University , Providence, Rhode Island, USA
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Do benefits restrictions limit Medicaid acceptance in addiction treatment? Results from a national study. J Subst Abuse Treat 2018; 87:50-55. [PMID: 29471926 DOI: 10.1016/j.jsat.2018.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the relationship of restrictions on Medicaid benefits for addiction treatment to Medicaid acceptance among addiction treatment programs. DATA SOURCES We collected primary data from the 2013-2014 wave of the National Drug Abuse Treatment System Survey. STUDY DESIGN We created two measures of benefits restrictiveness. In the first, we calculated the number of addiction treatment services covered by each state Medicaid program. In the second, we calculated the total number of utilization controls imposed on each service. Using a mixed-effects logistic regression model, we estimated the relationship between state Medicaid benefit restrictiveness for addiction treatment and adjusted odds of Medicaid acceptance among addiction treatment programs. DATA COLLECTION Study data come from a nationally-representative sample of 695 addiction treatment programs (85.5% response rate), representatives from Medicaid programs in forty-seven states and the District of Columbia (response rate 92%), and data collected by the American Society for Addiction Medicine. PRINCIPAL FINDINGS Addiction treatment programs in states with more restrictive Medicaid benefits for addiction treatment had lower odds of accepting Medicaid enrollees (AOR = 0.65; CI = 0.43, 0.97). The predicted probability of Medicaid acceptance was 35.4% in highly restrictive states, 48.3% in moderately restrictive states, and 61.2% in the least restrictive states. CONCLUSIONS Addiction treatment programs are more likely to accept Medicaid in states with less restrictive benefits for addiction treatment. Program ownership and technological infrastructure also play an important role in increasing Medicaid acceptance.
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Heinrich CJ, Fournier E. Instruments of Policy and Administration for Improving Substance Abuse Treatment Practice and Program Outcomes. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260503500304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The call for practice improvement in substance abuse treatment is motivated by the ultimate goal of achieving consistently positive post-treatment outcomes. A central hypothesis of the empirical investigation in this study is that consumer-level outcomes are affected either directly or indirectly through clinical practice, by factors originating at the policy and organizational level. Four broad categories of policy and program administration (funding, service technology and delivery, organizational structure, and leadership) that facilitate or hinder the implementation of practice improvements are investigated. Models hypothesizing that the effects of policy and program administration will vary according to the treatment goals and corresponding measurement of outcomes are tested. Using newly available data that link program- and consumer-level measures, the empirical analysis shows statistically significant direct effects of program and policy factors on outcomes as well as effects of these variables on treatment practices that have significant implications for treatment outcomes.
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Low Rates of Adoption and Implementation of Rapid HIV Testing in Substance Use Disorder Treatment Programs. J Subst Abuse Treat 2015; 63:46-53. [PMID: 26810130 DOI: 10.1016/j.jsat.2015.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/30/2015] [Accepted: 12/03/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Rapid HIV testing (RHT) greatly increases the proportion of clients who learn their test results. However, existing studies have not examined the adoption and implementation of RHT in programs treating persons with substance use disorders, one of the population groups at higher risk for HIV infection. METHODS We examined 196 opioid treatment programs (OTPs) using data from the 2011 National Drug Abuse Treatment System Survey (NDATSS). We used logistic regressions to identify client and organizational characteristics of OTPs associated with availability of on-site RHT. We then used zero-inflated negative binomial regressions to measure the association between the availability of RHT on-site and the number of clients tested for HIV. RESULTS Only 31.6% of OTPs offered on-site rapid HIV testing to their clients. Rapid HIV testing was more commonly available on-site in larger, publicly owned and better-staffed OTPs. On the other hand, on-site rapid HIV testing was less common in OTPs that prescribed only buprenorphine as a method of opioid dependence treatment. The availability of rapid HIV testing on-site reduced the likelihood that an OTP did not test any of its clients during the prior year. But on-site availability rapid HIV testing was not otherwise associated with an increased number of clients tested for HIV at an OTP. CONCLUSIONS New strategies are needed to a) promote the adoption of rapid HIV testing on-site in substance use disorder treatment programs and b) encourage substance use disorder treatment providers to offer rapid HIV testing to their clients when it is available.
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Provision of onsite HIV Services in Substance Use Disorder Treatment Programs: A Longitudinal Analysis. J Subst Abuse Treat 2015; 57:1-8. [PMID: 25934459 DOI: 10.1016/j.jsat.2015.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/20/2015] [Accepted: 04/08/2015] [Indexed: 11/23/2022]
Abstract
The provision of HIV education and testing in substance use disorder (SUD) treatment programs is an important public health strategy for reducing HIV incidence. For many at-risk individuals, SUD treatment represents the primary point of access for testing and receiving HIV-related services. This study uses two waves of nationally representative data of 265 privately-funded SUD treatment programs in the U.S. to examine organizational and patient characteristics associated with offering a dedicated HIV/AIDS treatment track, onsite HIV/AIDS support groups, and onsite HIV testing. Our longitudinal analysis indicated that the majority of treatment programs reported providing education and prevention services, but there was a small, yet significant, decline in the number of programs providing these services. Programs placed more of an emphasis on providing information on the transmission of HIV rather than on acquiring risk-reduction skills. There was a notable and significant increase (from 26.0% to 31.7%) in programs that offered onsite HIV testing, including rapid HIV testing, and an increase in the percentage of patients who received testing in the programs. Larger programs were more likely to offer a dedicated HIV/AIDS treatment track and to offer onsite HIV/AIDS support groups, while accredited programs and programs with a medical infrastructure were more likely to provide HIV testing. The percentage of injection drug users was positively linked to the availability of specialized HIV/AIDS tracks and HIV/AIDS support groups, and the percentage of female clients was associated with the availability of onsite support groups. The odds of offering HIV/AIDS support groups were also greater in programs that had a dedicated LGBT track. The findings suggest that access to hospitals and medical care services is an effective way to facilitate adoption of HIV services and that programs are providing a needed service among a group of patients who have a heightened risk of HIV transmission. Nonetheless, the fact that fewer than one third of programs offered onsite testing, and, of the ones that did, fewer than one third of their patients received testing, raises concern in light of federal guidelines.
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Heinrich CJ, Cummings GR. Adoption and diffusion of evidence-based addiction medications in substance abuse treatment. Health Serv Res 2014; 49:127-52. [PMID: 23855719 PMCID: PMC3922470 DOI: 10.1111/1475-6773.12093] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the roles of facility- and state-level factors in treatment facilities' adoption and diffusion of pharmaceutical agents used in addiction treatment. DATA SOURCES Secondary data from the National Survey of Substance Abuse Treatment Services (N-SSATS), Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Medicare and Medicaid Services, Alcohol Policy Information System, and Kaiser Family Foundation. STUDY DESIGN We estimate ordered logit and multinomial logit models to examine the relationship of state and treatment facility characteristics to the adoption and diffusion of three pharmaceutical agents over 4 years when each was at a different stage of adoption or diffusion. DATA COLLECTION N-SSATS data with facility codes, obtained directly from SAMHSA, were linked by state identifiers to the other publicly available, secondary data. PRINCIPAL FINDINGS The analysis confirms the importance of awareness and exposure to the adoption behavior of others, dissemination of information about the feasibility and effectiveness of innovations, geographical clustering, and licensing and accreditation in legitimizing facilities' adoption and continued use of pharmacotherapies in addiction treatment. CONCLUSIONS Policy and administrative levers exist to increase the availability of pharmaceutical technologies and their continued use by substance abuse treatment facilities.
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Affiliation(s)
- Carolyn J Heinrich
- Address correspondence to Carolyn J. Heinrich, Ph.D., Professor, Lyndon B. Johnson School of Public Affairs and Department of Economics, The University of Texas at Austin, P.O. Box Y, Austin, TX 78713-8925; e-mail: . Grant R. Cummings,MPA, is with the Wisconsin Legislative Fiscal Bureau, Madison, WI
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D'Aunno T, Pollack HA, Jiang L, Metsch LR, Friedmann PD. HIV testing in the nation's opioid treatment programs, 2005-2011: the role of state regulations. Health Serv Res 2013; 49:230-48. [PMID: 23855724 DOI: 10.1111/1475-6773.12094] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2013] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To identify the extent to which clients in a national sample of opioid treatment programs (OTPs) received HIV testing in 2005 and 2011; to examine relationships between state laws for informed consent and pretest counseling and rates of HIV testing among OTP clients. DATA SOURCE Data were collected from a nationally representative sample of OTPs in 2005 (n = 171) and 2011 (n = 200). STUDY DESIGN Random-effects logit and interval regression analyses were used to examine changes in HIV testing rates and the relationship of state laws to HIV testing among OTPs. DATA COLLECTION Data on OTP provision of HIV testing were collected in phone surveys from OTP managers; data also were collected on state laws for HIV testing. PRINCIPAL FINDINGS The percentage of OTPs offering HIV testing decreased significantly from 93 percent in 2005 to 64 percent in 2011. Similarly, the percentage of clients tested decreased from an average of 41 percent in 2005 to 17 percent in 2011. OTPs located in states whose laws do not require pretest counseling and that use opt-out consent were more likely to provide HIV testing and to test higher percentages of clients. CONCLUSIONS The results show the need to increase HIV testing among OTP clients; the results also underscore the beneficial possibilities of dropping pretest counseling as a requirement for HIV testing and of using the opt-out approach to informed consent for testing.
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Affiliation(s)
- Thomas D'Aunno
- Mailman School of Public Health, Columbia University, 600W. 168th St., New York, NY, 10032
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Abraham AJ, Knudsen HK, Rieckmann T, Roman PM. Disparities in access to physicians and medications for the treatment of substance use disorders between publicly and privately funded treatment programs in the United States. J Stud Alcohol Drugs 2013; 74:258-65. [PMID: 23384373 PMCID: PMC3568164 DOI: 10.15288/jsad.2013.74.258] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 10/28/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Prior research suggests that publicly funded substance use disorder (SUD) treatment programs lag behind privately funded programs in adoption of evidence-based practices, resulting in disparities in access to high-quality SUD treatment. These disparities highlight a critical public health concern because the majority of SUD patients in the United States are treated in the publicly funded treatment sector. This study uses recent data to examine disparities in access to physicians and availability of medications for the treatment of SUDs between publicly and privately funded SUD treatment programs. METHOD Data were collected from 595 specialty SUD treatment programs from 2007 to 2010 via face-to-face interviews, mailed surveys, and telephone interviews with treatment program administrators. RESULTS Publicly funded programs were less likely than privately funded programs to have a physician on staff, even after controlling for several organizational characteristics that were associated with access to physicians. The results of negative binomial regression indicated that, even after taking into account physician access and other organizational variables, publicly funded programs prescribed fewer SUD medications than privately funded SUD treatment programs. CONCLUSIONS Patients seeking treatment in publicly funded treatment programs continue to face disparities in access to high-quality SUD treatment that supports patients' choices among a range of medication options. However, implementation of the Affordable Care Act may facilitate greater access to physicians and use of medications in publicly funded SUD treatment programs.
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Affiliation(s)
- Amanda J Abraham
- Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina 29208, USA.
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McBride DC, Chriqui JF, Terry-McElrath YM, Mulatu MS. Drug treatment program ownership, Medicaid acceptance, and service provision. J Subst Abuse Treat 2012; 42:116-24. [DOI: 10.1016/j.jsat.2011.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 09/27/2011] [Accepted: 10/18/2011] [Indexed: 11/25/2022]
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Knudsen HK, Abraham AJ, Oser CB. Barriers to the implementation of medication-assisted treatment for substance use disorders: the importance of funding policies and medical infrastructure. EVALUATION AND PROGRAM PLANNING 2011; 34:375-81. [PMID: 21371752 PMCID: PMC3114165 DOI: 10.1016/j.evalprogplan.2011.02.004] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Despite growing interest in the use of evidence-based treatment practices, adoption of pharmacotherapies for treating substance use disorders (SUDs) remains modest. Using data from telephone interviews with 250 administrators of publicly funded SUD treatment programs, this study estimated a model of adoption of medication assisted treatment (MAT) for SUDs and examined the relative importance of regulatory, cultural, medical resource, patient-level, and funding barriers to MAT implementation. MAT-adopting programs had significantly greater medical resources, as measured by the employment of physicians and nurses, than non-adopting programs. Administrators of non-adopting programs were asked to rate the importance of 18 barriers to MAT implementation. The most strongly endorsed barriers were regulatory prohibitions due to the program's lack of medical staff, funding barriers to implementing MAT, and lack of access to medical personnel with expertise in delivering MAT. Barriers related to insufficient information about MAT and unsupportive staff attitudes were not widely endorsed. These findings suggest that efforts to promote the implementation of MAT that are inattentive to funding barriers and weaknesses in medical infrastructure may achieve sub-optimal results.
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Affiliation(s)
- Hannah K. Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky
| | | | - Carrie B. Oser
- Department of Sociology and Center on Drug and Alcohol Research, University of Kentucky
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Pollack HA, D'Aunno T. HIV testing and counseling in the nation's outpatient substance abuse treatment system, 1995-2005. J Subst Abuse Treat 2010; 38:307-16. [PMID: 20171038 DOI: 10.1016/j.jsat.2009.12.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 11/02/2009] [Accepted: 12/31/2009] [Indexed: 11/16/2022]
Abstract
This article examines the extent to which U.S. outpatient substance abuse treatment (OSAT) facilities provide HIV counseling and testing (C&T) to clients between 1995 and 2005. We also examine organizational and client characteristics associated with OSAT facilities' provision of HIV C&T. Data were collected from a nationally representative sample of outpatient treatment facilities in 1995 (n = 618), 2000 (n = 571), and 2005 (n = 566). Results show that in 1995, 26.8% of OSAT clients received HIV C & T; by 2005, this proportion had increased, but only to 28.8%. Further, results from random-effects interval regression analysis show that C&T is especially widespread in public and nonprofit facilities, in methadone facilities, and in units that serve injection drug users and commercial sex workers. HIV C&T was also more widespread in units that employed formal intake protocols. Despite widespread efforts to increase HIV C&T services in OSAT care, only a small and stable minority of clients receive these services. Adoption of formal intake procedures may provide one vehicle to increase provision of C&T services.
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Knudsen HK. Smoking Cessation Services in Adolescent Substance Abuse Treatment: Opportunities Missed? JOURNAL OF DRUG ISSUES 2009; 39:257-276. [DOI: 10.1177/002204260903900202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The majority of adolescents receiving substance abuse treatment also use tobacco, yet there are few data regarding the adoption of tobacco use assessment and smoking cessation services by adolescent treatment programs. Using data from a national sample of adolescent-only treatment programs (n = 154), this research measures the adoption of aspects of assessment and treatment from the Public Health Service's (2000) guideline, Treating Tobacco Use and Dependence. When adoption of four intake/assessment practices was measured, adoption appeared high, but only 45% of programs had adopted all four practices. About 43% of programs offered some type of smoking cessation services. However, there was no association between adoption of intake procedures and the odds of availability of smoking cessation services, suggesting a lack of connection between the identification of treatment needs and the availability of services. The lack of smoking cessation services may represent a missed opportunity for early intervention with this population.
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Nahra TA, Alexander J, Pollack H. Influence of ownership on access in outpatient substance abuse treatment. J Subst Abuse Treat 2009; 36:355-65. [PMID: 19339142 DOI: 10.1016/j.jsat.2008.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 05/16/2008] [Accepted: 06/22/2008] [Indexed: 11/26/2022]
Abstract
Marked changes in ownership and control in substance abuse treatment delivery have garnered the attention of providers and policymakers alike. The proliferation of private for-profit providers and the shift to a delivery system that may be more explicitly influenced by financial incentives are of particular concern for this vulnerable population. This work empirically addresses how treatment unit ownership affected access and retention between 1995 and 2005 in the United States. Regressions show statistically significant associations between unit ownership and both restricted treatment access and shortening of treatment duration for financial reasons. In comparison to private nonprofit and public units, private for-profit units were less likely to provide initial treatment access and reported shortened treatment for a greater percentage of clients unable to pay. Other organization characteristics, such as methadone-maintenance programs and managed care participation, also were associated with limiting treatment accessibility. While this work does not determine the underlying motivation behind access limitations, continued shifts in ownership structure should heighten the attention of policymakers.
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Affiliation(s)
- Tammie A Nahra
- Department of Health Management and Policy, The University of Michigan, 109 S Observatory, Ann Arbor, MI 48109-2029, USA.
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Walker MA. Program Characteristics and the Length of Time Clients are in Substance Abuse Treatment. J Behav Health Serv Res 2008; 36:330-43. [DOI: 10.1007/s11414-008-9128-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 05/14/2008] [Indexed: 10/21/2022]
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Woodward AM, Raskin IE, Blacklow B. A profile of the substance abuse treatment industry: organization, costs, and treatment completion. Subst Use Misuse 2008; 43:647-79. [PMID: 18393082 DOI: 10.1080/10826080601096640] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Nationally representative data from the Alcohol and Drug Services Study, conducted between 1996 and 1999, are used to explore the structure and operation of the substance user treatment industry in the United States. The empirical relationship among client (N=4945) retention and completion, types and use of counseling and medical personnel, diagnostic mix, client demographics, the level of services used, and the cost of treatment in different treatment settings is discussed using tabular presentation and tests of significance. Limitations of the analysis are outlined. This information and analysis are expected to help the research community understand the potential of the ADSS data in addressing many important questions about substance user treatment.
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Knudsen HK, Ducharme LJ, Roman PM. The use of antidepressant medications in substance abuse treatment: the public-private distinction, organizational compatibility, and the environment. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2007; 48:195-210. [PMID: 17583274 DOI: 10.1177/002214650704800207] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Many studies of innovation adoption in health care organizations focus either on organizational characteristics or the institutional environment, but not both. Furthermore, these perspectives are rarely employed simultaneously in both public and private health care organizations. This research considers the public-private distinction, organizational compatibility, and interorganizational referral relationships in the use of selective serotonin reuptake inhibitors (SSRIs) by substance abuse treatment organizations. Using data from nationally representative samples of 363 publicly funded and 403 privately funded substance abuse treatment centers, a four-category typology of public and private organizations initially predicted variation in SSRI use. However some differences were no longer significant once organizational and environmental characteristics were added to the statistical model. These data support hypotheses about the associations between organizational characteristics and SSRI use as well as hypotheses regarding the external environment. Future research should continue to integrate both internal and external factors in theoretical explanations of innovation adoption.
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Affiliation(s)
- Hannah K Knudsen
- University of Georgia, Center for Research on Behavioral Health and Human Services Delivery, 101 Barrow Hall, Athens, GA 30602-2401, USA.
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Coustasse A, Singh KP, Trevino FM. Disparities in access to healthcare: the case of a drug and alcohol abuse detoxification treatment program among minority groups in a Texas hospital. Hosp Top 2007; 85:27-34. [PMID: 17405422 DOI: 10.3200/htps.85.1.27-34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The authors analyzed ethnic/racial disparities in healthcare access and length of stay from a defined population of individuals seeking medical detoxification services at a hospital in Texas. Results indicated Blacks were more likely to be insured compared with Whites, mostly by public insurance, but this did not hold for Hispanics, who were about three times more likely to be uninsured compared with Blacks. In addition, the authors observed lower median of length of stay in the Medicaid category among Hispanics. These results can be explained by aggressive case management, sociocultural barriers, or discriminatory practices, both intentional and unintentional.
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Affiliation(s)
- Alberto Coustasse
- Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Coustasse A, Singh KP, Lurie SG, Lin YS, Coggin CS, Trevino F. Gender disparities: a medical detoxification program. JOURNAL OF HOSPITAL MARKETING & PUBLIC RELATIONS 2007; 18:21-37. [PMID: 18453134 DOI: 10.1300/j375v18n01_03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Significant gaps exist in health care regarding gender in the United States. Health status, social roles, culturally patterned behavior and access to health care can be influenced by gender. Women have been the primary users of health care and minority women usually have received poorer quality care than Non-Hispanic White (NHW) females. The objectives of this study were to identify gender, racial and ethnic disparities in access to substance abuse treatment in a Texas hospital. Secondary data collected on 1,309 subjects who underwent detoxification were studied. Gender, race/ethnicity, drug of abuse, relapse and financial classification were included in the analysis. Results indicate Hispanic females and Non-Hispanic Black (NHB) females were about 5 and 3.5 more likely than NHW females to use Medicaid services respectively (p < .05). NHW and NHB males were more likely to use Medicare than females (p < .05). NHB and Hispanic females were 5.8 and 2.1 times more likely to receive care for abuse of cocaine when compared to NHW females respectively (p < .05). Hispanic females were 2.3 times more likely to relapse than Non-Hispanic females, and uninsured NHB females were 7.1 times at a higher risk to abuse multiple drugs compare to NHW females (p < .05). Socio-economic factors, lower labor force participation rates, and less financial independence can explain females utilizing more often Medicaid regardless of their race/ethnicity. These results can be also explained by aggressive case management utilization, socio cultural barriers and/or discriminatory practices, both intentional and unintentional.
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Affiliation(s)
- Alberto Coustasse
- Health Management and Policy Department, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
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Woodward A, Das A, Raskin IE, Morgan-Lopez AA. An exploratory analysis of treatment completion and client and organizational factors using hierarchical linear modeling. EVALUATION AND PROGRAM PLANNING 2006; 29:335-351. [PMID: 17950862 DOI: 10.1016/j.evalprogplan.2006.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Data from the Alcohol and Drug Services Study (ADSS) are used to analyze the structure and operation of the substance abuse treatment industry in the United States. Published literature contains little systematic empirical analysis of the interaction between organizational characteristics and treatment outcomes. This paper addresses that deficit. It develops and tests a hierarchical linear model (HLM) to address questions about the empirical relationship between treatment inputs (industry costs, types and use of counseling and medical personnel, diagnosis mix, patient demographics, and the nature and level of services used in substance abuse treatment), and patient outcomes (retention and treatment completion rates). The paper adds to the literature by demonstrating a direct and statistically significant link between treatment completion and the organizational and staffing structure of the treatment setting. Related reimbursement issues, questions for future analysis, and limitations of the ADSS for this analysis are discussed.
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Affiliation(s)
- Albert Woodward
- Department of Research & Development, American College of Cardiology, 2400 N St. NW, Washington, DC, 20037, USA
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Friedmann PD, Alexander JA, Yey Y, Nahra T, Soliman S, Pollack HA. Duration of Nonmethadone Outpatient Treatment. Subst Abus 2006; 27:47-53. [PMID: 17135180 DOI: 10.1300/j465v27n03_07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study examined organizational trends from 1990 to 2000 and unit characteristics associated with the duration of nonmethadone outpatient addiction treatment. METHODS Program directors and clinical supervisors from a nationally representative panel of nonmethadone outpatient units in the United States were surveyed in 1990, 1995, and 2000. Treatment duration was measured from clinical supervisors' reports of the average length of stay. Negative binominal regression models controlled for multivariate effects. RESULTS Treatment duration modestly declined between 1990 and 2000 while addiction severity increased. Affiliation with a mental health center, older program age, JCAHO accreditation-ostensibly a marker for structural quality-and serving more clients with prior authorization requirements- a measure of managed care stringency-were associated with shorter treatment durations. CONCLUSIONS These findings suggest that treatment duration did not increase between 1990 and 2000 despite clients' worsening addiction severity and growing evidence that longer duration of formal treatment improves treatment outcome. In addition, programs with JCAHO accreditation and stronger managed care oversight appeared to seek efficiencies through reductions in treatment duration.
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Affiliation(s)
- Peter D Friedmann
- Providence Veterans Affairs Medical Center, Division of General Internal Medicine, Department of Medicine, Brown University School of Medicine and Rhode Island Hospital, Providence, RI 02903, USA.
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Timko C, Debenedetti A, Moos BS, Moos RH. Predictors of 16-Year Mortality Among Individuals Initiating Help-Seeking for an Alcoholic Use Disorder. Alcohol Clin Exp Res 2006; 30:1711-20. [PMID: 17010138 DOI: 10.1111/j.1530-0277.2006.00206.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND METHODS We examined rates and predictors of mortality in individuals (47% women) who had just initiated help-seeking for their alcohol use disorders (AUDs) at the start of the study (n=628) and were followed for 16 years. RESULTS For both women and men, the observed-to-expected mortality ratio (1.4) was lower than rates found in samples of treated individuals with AUDs, suggesting that those initiating help-seeking careers have better chances of long-term survival. Of the individuals for whom cause of death was known, 68% died of alcohol-related causes. Men were more likely to die than were women. When gender was controlled, individuals who were older and unmarried and had more alcohol dependence symptoms at baseline were more likely to die over the 16-year period. When these baseline characteristics were controlled, better drinking outcomes at 1 year were associated with a lower likelihood of subsequent death. The combination of a shorter duration of inpatient/residential care and better drinking outcomes at 1 year was related to a lower probability of death, as was the combination of a longer duration of outpatient care or Alcoholics Anonymous attendance and better drinking outcomes at 1 year. CONCLUSIONS Efforts should be made to help providers identify individuals who are not responding positively to inpatient or residential treatment and intervene to motivate participation in continuing outpatient care and community 12-step self-help groups to reduce the likelihood of a chronic and fatal AUD course.
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Affiliation(s)
- Christine Timko
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford University Medical Center, Menlo Park, California 94025, USA.
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25
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Pollack HA, D'Aunno T, Lamar B. Outpatient substance abuse treatment and HIV prevention: an update. J Subst Abuse Treat 2006; 30:39-47. [PMID: 16377451 DOI: 10.1016/j.jsat.2005.09.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Revised: 09/21/2005] [Accepted: 09/27/2005] [Indexed: 10/25/2022]
Abstract
Testing and counseling, along with community outreach, have been identified as valuable in the prevention of human immunodeficiency virus (HIV) and other blood-borne diseases. This article assesses the extent to which outpatient substance abuse treatment (OSAT) programs provide such services. Longitudinal data for 1988-2000 were analyzed from the National Drug Abuse Treatment System Survey (NDATSS). Random-effects regression was used to examine factors associated with the provision of prevention services. HIV testing, which had became more common between 1990 and 1995, continued to proliferate between 1995 and 2000. The proportion of units that provide HIV testing and counseling increased from 66% to 86%. The proportion of units that provide HIV community outreach increased significantly before 1995 but then slightly decreased from 77% to 73% between 1995 and 2000. In conclusion, HIV testing and counseling widely proliferated in OSAT care. However, OSAT units remain less likely to offer HIV community outreach services.
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Wells R, Lemak CH, D'Aunno TA. Organizational survival in the outpatient substance abuse treatment sector, 1988-2000. Med Care Res Rev 2006; 62:697-719. [PMID: 16330821 DOI: 10.1177/1077558705281062] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Substance abuse remains one of the most pressing health issues in the United States today, yet treatment supply continues to lag far behind need. Given the hostile environments treatment facilities face, their survival is a matter of pressing policy concern. Results from analyses of National Drug Abuse Treatment System Survey (NDATSS) data from 1988 through 2000 suggest that organizational attributes such as age, size, and client severity and resource dependencies such as reliance on government revenue affect survival, but their effects change over time. By the mid-1990s, director involvement in state and local policy making was positively associated with subsequent survival; later that decade, directors' professional credentials affected survival as well. Results also show that serving clients with multiple substance abuse problems became a survival liability by the late 1990s. Facilities that treat clients with multiple addictions may need additional financial support to serve these particularly vulnerable clients.
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Olmstead TA, Sindelar JL. Does the impact of managed care on substance abuse treatment services vary by provider profit status? Health Serv Res 2005; 40:1862-82. [PMID: 16336553 PMCID: PMC1361225 DOI: 10.1111/j.1475-6773.2005.00431.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To extend our previous research by determining whether, and how, the impact of managed care (MC) on substance abuse treatment (SAT) services differs by facility ownership. DATA SOURCES The 2000 National Survey of Substance Abuse Treatment Services, which is designed to collect data on service offerings and other characteristics of SAT facilities in the U.S. These data are merged with data from the 2002 Area Resource File, a county-specific database containing information on population and MC activity. We use data on 10,513 facilities, virtually a census of all SAT facilities. STUDY DESIGN For each facility ownership type (for-profit [FP], not-for-profit [NFP], public), we estimate the impact of MC on the number and types of SAT services offered. We use instrumental variables techniques that account for possible endogeneity between facilities' involvement in MC and service offerings. PRINCIPAL FINDINGS We find that the impact of MC on SAT service offerings differs in magnitude and direction by facility ownership. On average, MC causes FPs to offer approximately four additional services, causes publics to offer approximately four fewer services, and has no impact on the number of services offered by NFPs. The differential impact of MC on FPs and publics appears to be concentrated in therapy/counseling, medical testing, and transitional services. CONCLUSION Our findings raise policy concerns that MC may reduce the quality of care provided by public SAT facilities by limiting the range of services offered. On the other hand, we find that FP clinics increase their range of services. One explanation is that MC results in standardization of service offerings across facilities of different ownership type. Further research is needed to better understand both the specific mechanisms of MC on SAT and the net impact on society.
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Olmstead T, Sindelar JL. To what extent are key services offered in treatment programs for special populations? J Subst Abuse Treat 2004; 27:9-15. [PMID: 15223088 DOI: 10.1016/j.jsat.2004.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2003] [Revised: 10/02/2003] [Accepted: 03/26/2004] [Indexed: 10/26/2022]
Abstract
Many substance abuse treatment (SAT) facilities offer programs designed specifically for special populations such as women, adolescents, gays/lesbians and others. Previous research shows that there are specific services that are integral to the successful treatment of these populations (e.g., family therapy for adolescents, childcare and transportation assistance for women, and HIV testing and counseling for gays/lesbians). This study examines whether facilities that self-report having programs for special populations actually offer the recommended services. The data come from the 2000 National Survey of Substance Abuse Treatment Services, which contains information on service offerings, special programs and other characteristics for all SAT facilities in the USA. The results indicate that facilities with special programs are more likely to offer the recommended key services. However, often less than half of these facilities provide the key services. There are consistent differences by ownership status, with for-profit facilities less likely to offer many of the key services.
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Heinrich CJ, Fournier E. Dimensions of publicness and performance in substance abuse treatment organizations. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2004; 23:49-70. [PMID: 14976993 DOI: 10.1002/pam.10178] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Changes in funding, clientele, and treatment practices of public and privately owned substance abuse treatment programs, compelled in part by increased cost containment pressures, have prompted researchers' investigations of the implications of organizational form for treatment programs. These studies primarily probe associations between ownership status, patient characteristics, and services delivered and do not empirically link organizational form or structure to treatment outcomes. Data from the National Treatment Improvement Evaluation Study (NTIES) were used to study the relationship of ownership and other dimensions of publicness identified in the public management literature to patient outcomes, controlling for patient characteristics, treatment experiences, and other program characteristics. A few effects of organizational form and structure on substance abuse treatment outcomes are statistically significant (primarily improved social functioning), although the specific contributions of measures of ownership and publicness to explaining program-level variation are generally small.
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Affiliation(s)
- Carolyn J Heinrich
- LaFollette School of Public Affairs, University of Wisconsin-Madison, USA
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30
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Friedmann PD, Lemon SC, Stein MD, D'Aunno TA. Accessibility of addiction treatment: results from a national survey of outpatient substance abuse treatment organizations. Health Serv Res 2003; 38:887-903. [PMID: 12822917 PMCID: PMC1360921 DOI: 10.1111/1475-6773.00151] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Peter D Friedmann
- Division of General Internal Medicine, Rhode Island Hospital, Providence 02903, USA
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31
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Abstract
OBJECTIVE To investigate whether a performance-based contracting (PBC) system provides incentives for nonprofit providers of substance abuse treatment to select less severe clients into treatment. DATA SOURCES The Maine Addiction Treatment System (MATS) standardized admission and discharge data provided by the Maine Office of Substance Abuse (OSA) for fiscal years 1991-1995, provides demographic, substance abuse, and social functional information on clients of programs receiving public funding. STUDY DESIGN We focused on OSA clients (i.e., those patients whose treatment cost was covered by the funding from OSA) and Medicaid clients in outpatient programs. Clients were identified as being "most severe" or not. We compared the likelihood for OSA clients to be "most severe" before PBC and after PBC using Medicaid clients as the control. Multivariate regression analysis was employed to predict the marginal effect of PBC on the probability of OSA clients being most severe after controlling for other factors. PRINCIPAL FINDINGS The percentage of OSA outpatient clients classified as most severe users dropped by 7 percent (p < = 0.001) after the innovation of performance-based contracting compared to the increase of 2 percent for Medicaid clients. The regression results also showed that PBC had a significantly negative marginal effect on the probability of OSA clients being most severe. CONCLUSIONS Performance-based contracting gave providers of substance abuse treatment financial incentives to treat less severe OSA clients in order to improve their performance outcomes. Fewer OSA clients with the greatest severity were treated in outpatient programs with the implementation of PBC. These results suggest that regulators, or payers, should evaluate programs comprehensively taking this type of selection behavior into consideration.
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Affiliation(s)
- Yujing Shen
- Boston University School of Public Health, MA, USA
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32
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Friedmann PD, Lemon SC, Durkin EM, D'Aunno TA. Trends in comprehensive service availability in outpatient drug abuse treatment. J Subst Abuse Treat 2003; 24:81-8. [PMID: 12646334 PMCID: PMC3668548 DOI: 10.1016/s0740-5472(02)00323-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Comprehensive medical and psychosocial services are essential to quality addiction treatment, but their availability declined in the 1980s. To determine whether this downward trend in the availability of comprehensive services continued in the 1990s, we analyzed data from a national panel study of outpatient substance abuse treatment units in 1990, 1995, and 2000. Response rates were greater than 85%. Regarding the availability of comprehensive services, including physical examinations, routine medical care, mental health services, financial counseling and employment counseling, administrators reported whether any substance abuse treatment client received the service in the past year. With the exception of physical examinations, whose reported availability increased from 1990 to 1995, and financial counseling, whose reported availability decreased during the same time, the reported availability of comprehensive services changed little during the 1990s. These findings highlight the continuing need to monitor access to comprehensive services and other quality markers in addiction treatment over time.
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Affiliation(s)
- Peter D Friedmann
- Department of General Internal Medicine, Rhode Island Hospital, Providence, RI 20903, USA.
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Heinrich CJ, Lynn LE. Improving the organization, management, and outcomes of substance abuse treatment programs. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2002; 28:601-22. [PMID: 12492259 DOI: 10.1081/ada-120015871] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study presents an organizing framework for empirical analyses of substance abuse treatment program effectiveness, based on relevant theories of organization and public management and the body of substance abuse treatment studies, and is applied in analyses of treatment program data. METHOD We use descriptive analyses of data from the National Treatment Improvement Evaluation Study that were collected from 519 substance abuse treatment service delivery units and 6593 patients to identify instruments of policy and management that might either frustrate or facilitate the implementation of "best practices" in substance abuse treatment. RESULTS The analyses show statistically significant and substantively interesting relationships among measures of organizational structure and mission, financial management (e.g., revenues per patient and revenue sources), human resources management (e.g., staffing levels, the use of case managers, etc.), and measures of service technology (e.g., the provision of supportive services, counseling intensity, etc.). CONCLUSION Researchers should strive to measure and account for the significant interactions among structural, management, and service technology variables in substance abuse treatment programs and the impact of these variables, mediated through patient characteristics and pre-treatment histories, on treatment outcomes.
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Affiliation(s)
- Carolyn J Heinrich
- University of North Carolina at Chapel Hill, Abernethy Hall, CB #3435, Chapel Hill, NC 27599-3435, USA.
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34
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Lemak CH, Alexander JA. Managed care and outpatient substance abuse treatment intensity. J Behav Health Serv Res 2001; 28:12-29. [PMID: 11329996 DOI: 10.1007/bf02287231] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examines the extent to which managed care behavioral controls are associated with treatment intensity in outpatient substance abuse treatment facilities. Data are from the 1995 National Drug Abuse Treatment System Survey, a nationally representative survey that includes over 600 provider organizations with a response rate of 86%. Treatment intensity is measured in three ways: (1) the number of months clients spend in outpatient drug treatment, (2) the number of individual treatment sessions clients receive over the course of treatment, and (3) the number of group treatment sessions clients receive over the course of treatment. After accounting for selection bias and controlling for market, organization, and client characteristics, there is no significant relationship between the scope of managed care oversight and treatment intensity. However, the stringency of managed care oversight activities is negatively associated with the number of individual and group treatment sessions received over the course of treatment.
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Affiliation(s)
- C H Lemak
- Department of Health Services Administration, University of Florida, P.O. Box 100195, Gainesville, FL 32610-0195, USA.
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