Stahler Gerald J, Mazzella Silvana, Mennis Jeremy, Chakravorty Sanjoy, Rengert George, Spiga Ralph
Department of Geography and Urban Studies, 309 Gladfelter Hall, Temple University (025-27), Philadelphia, PA 19122, USA.
Drug Alcohol Depend. 2007 Feb 23;87(1):54-62. doi: 10.1016/j.drugalcdep.2006.07.010. Epub 2006 Sep 7.
This study reviewed the medical charts of 271 patients diagnosed with co-morbid mental health and substance-use disorders who were discharged from a hospital acute inpatient unit to various outpatient treatment programs in Philadelphia. Geographic Information Systems (GIS) technology and logistic regression modeling were employed to investigate the effects of individual, neighborhood, and program-level variables on arrival to the first treatment appointment within 30 days of discharge. Four models are presented. The results of the study suggest that having had three or more treatment episodes prior to inpatient hospitalization, and living in a neighborhood in which temporary or transitional, and presumably, other low income housing is located, increased the likelihood of patients continuing with treatment in the community. Discharge to the preadmission address, a chief complaint of bizarre behavior, close proximity of two or more liquor and/or beer stores, a high density of narcotics anonymous (NA) and/or alcoholics anonymous (AA) meetings within the neighborhood, an axis I diagnosis of substance-induced mood disorder, and a urine drug screen positive for heroin reduced the likelihood of attending outpatient treatment. We conclude that geographic and community variables as they relate to substance abuse may add an important dimension to our understanding of patient functioning and well being in the community following inpatient treatment.
本研究回顾了271名被诊断患有合并精神健康和物质使用障碍的患者的病历，这些患者从费城一家医院的急性住院部出院后，进入了各种门诊治疗项目。采用地理信息系统（GIS）技术和逻辑回归模型，研究个体、社区和项目层面的变量对出院后30天内首次治疗预约就诊率的影响。文中呈现了四个模型。研究结果表明，住院前有三次或更多次治疗经历，以及居住在有临时或过渡性住房且可能还有其他低收入住房的社区，会增加患者在社区继续接受治疗的可能性。出院后回到入院前地址、主要诉求为怪异行为、附近有两家或更多家酒类和/或啤酒商店、社区内匿名戒毒会（NA）和/或匿名戒酒会（AA）会议密度高、轴I诊断为物质所致心境障碍以及尿液药物筛查显示海洛因呈阳性，这些因素会降低门诊治疗的就诊率。我们得出结论，与药物滥用相关的地理和社区变量可能会为我们理解住院治疗后患者在社区中的功能和健康状况增添一个重要维度。
