Garnick Deborah W, Horgan Constance M, Acevedo Andrea, Lee Margaret T, Panas Lee, Ritter Grant A, Campbell Kevin
The Heller School for Social Policy and Management, Institute for Behavioral Health, Brandeis University, Waltham, Massachusetts.
Department of Community Health, Tufts University, Medford, Massachusetts.
J Rural Health. 2020 Mar;36(2):196-207. doi: 10.1111/jrh.12375. Epub 2019 May 15.
Treatment after discharge from detoxification or residential treatment is associated with improved outcomes. We examined the influence of travel time on continuity into follow-up treatment and whether financial incentives and weekly alerts have a modifying effect.
For a research intervention during October 2013 to December 2015, detoxification and residential substance use disorder treatment programs in Washington State were randomized into 4 groups: potential financial incentives for meeting performance goals, weekly alerts to providers, both interventions, and control. Travel time was used as both a main effect and interacted with other variables to explore its modifying impact on continuity of care in conjunction with incentives or alerts. Continuity was defined as follow-up care occurring within 14 days of discharge from detoxification or residential treatment programs. Travel time was estimated as driving time from clients' home ZIP Code to treatment agency ZIP Code.
Travel times to the original treatment agency were in some cases significant with longer travel times predicting lower likelihood of continuity. For detoxification clients, those with longer travel times (over 91 minutes from their residence) are more likely to have timely continuity. Conversely, residential clients with travel times of more than 1 hour are less likely to have timely continuity. Interventions such as alerts or incentives for performance had some mitigating effects on these results. Travel times to the closest agency for potential further treatment were not significant.
Among rural clients discharged from detoxification and residential treatment, travel time can be an important factor in predicting timely continuity.
戒毒或住院治疗出院后的后续治疗与改善治疗效果相关。我们研究了出行时间对后续治疗连续性的影响，以及经济激励措施和每周提醒是否具有调节作用。
在2013年10月至2015年12月期间的一项研究干预中，华盛顿州的戒毒和住院物质使用障碍治疗项目被随机分为4组：达到绩效目标的潜在经济激励措施、向提供者发送每周提醒、两种干预措施同时实施以及对照组。出行时间既作为一个主要影响因素，又与其他变量相互作用，以探讨其与激励措施或提醒相结合时对连续护理的调节影响。连续性被定义为在戒毒或住院治疗项目出院后14天内接受后续护理。出行时间被估计为从客户家庭邮政编码所在地到治疗机构邮政编码所在地的驾车时间。
前往原治疗机构的出行时间在某些情况下具有显著影响，出行时间越长，连续性的可能性越低。对于戒毒客户，出行时间较长（从其住所超过91分钟）的客户更有可能及时实现连续性。相反，出行时间超过1小时的住院客户及时实现连续性的可能性较小。提醒或绩效激励等干预措施对这些结果有一定的缓解作用。前往最接近的潜在进一步治疗机构的出行时间不具有显著性。
在从戒毒和住院治疗出院的农村客户中，出行时间可能是预测及时连续性的一个重要因素。
