Definition of service areas for substance abuse treatment agencies

A spatial analysis of community disadvantage and access to healthcare services in the U.S

Ongoing socioeconomic and racial and ethnic gaps in access to healthcare make it vital to examine the relationship between characteristics of communities and their impact on the availability of healthcare services. This study investigates how community-based resource constraints influence the provision of healthcare services in the United States. Drawing on several theoretical frameworks including research in the spatial distribution of healthcare, we compile data on 3141 U.S. counties in order to investigate the argument that gaps in the provision of substance abuse treatment are a function of resource constraints experienced by disadvantaged communities. Our principal aim is to demonstrate that socioeconomic privation, racial and ethnic isolation and limited healthcare infrastructure constrain the provision of substance abuse treatment services. Since prior research shows spatial clustering of socioeconomic privation, racial and ethnic isolation, and healthcare resources, we explicitly model the spatial dimensions of community-based resource disadvantage. Central findings support our chief expectations: counties with greater socioeconomic privation and diminished healthcare infrastructure experienced limited access to substance abuse treatment. Moreover, treatment clusters themselves were significantly related to socioeconomic privation and diminished healthcare infrastructure. Counties with a higher proportion of racial and ethnic minority members, however, did not experience less access to substance abuse treatment, with one exception, although post hoc analyses showed poverty had a moderating effect on race and ethnicity. Study limitations and implications for the organization of treatment resources are discussed.

Research on rural residence and access to drug abuse services: where are we and where do we go?

CONTEXT

Illicit drug use is common in rural areas, but very little research has investigated rural populations' access to drug abuse services.

PURPOSE

To describe the current state of the scientific literature on access to drug abuse services in rural areas and suggest directions for future research.

METHODS

We performed a literature review of published articles on rural drug abuse services and summarized the findings according to potential, realized, accommodating, and acceptable access. Relevant articles on rural access to medical, alcohol, and mental health care were selected to supplement the scarce literature specific to drug abuse.

FINDINGS

A limited body of work indicates that rural populations have lower availability and utilize needed drug abuse services less frequently than their urban counterparts. Even less is known about the accommodation and acceptability of drug abuse programs serving rural populations.

CONCLUSIONS

Research that investigates the existence and determinants of problems with access to drug abuse services is greatly needed to enable policy makers, drug treatment managers, and practitioners to better meet the needs of their rural clientele. As this field of inquiry advances, methodologies for constructing drug abuse service areas and measuring consumers' evaluations must be developed.