Guerrero Erick G, Alibrahim Abdullah, Howard Daniel L, Wu Shinyi, D'Aunno Thomas
I-LEAD Institute, Research to End Healthcare Disparities Corp, United States.
Kuwait University, College of Engineering & Petroleum, Kuwait.
Int J Drug Policy. 2020 Dec;86:102948. doi: 10.1016/j.drugpo.2020.102948. Epub 2020 Sep 22.
Little is known about the stability of public drug treatment in the United States to deliver services in an era of expansion of public insurance. Guided by organizational theories, we examined the role of program size, and performance (i.e., rates of treatment initiation and engagement) on discontinuing services in one of the largest treatment systems in the United States.
This study relied on multi-year (2006-2014) administrative data of 249,029 treatment admission episodes from 482 treatment programs in Los Angeles County, CA. We relied on survival regression analysis to identify associations between program size, treatment initiation (wait time) and engagement (retention and completion rates) and discontinuing services in any given year. We examined program differences between discontinued versus sustained services in pre- and post-expansion periods.
Sixty-two percent of programs discontinued services at some point between 2006 and 2014. Program size and rates of treatment retention were negatively associated with risk of discontinuing services. Proportion of female clients was also negatively associated with risk of discontinuing services. Compared to residential programs, methadone programs were associated with reduced likelihood of discontinuing services. Two interactions were significant; program size and retention rates, as well as program size and completion rates were negatively associated with risk of discontinuing services.
Program size (large), type (methadone), performance (retention) and client population (women) were associated with stability in this drug treatment system. Because more than 70% of programs in this system are small, it is critical to support their capacity to sustain services to reduce existing disparities in access to care. We discuss the implications of these findings for system evaluation and for responding to public health crises.
在美国公共保险扩张的时代，对于公共药物治疗提供服务的稳定性知之甚少。在组织理论的指导下，我们研究了项目规模和绩效（即治疗启动率和参与率）在美国最大的治疗系统之一中对服务中断的作用。
本研究依赖于加利福尼亚州洛杉矶县482个治疗项目的249,029例治疗入院事件的多年（2006 - 2014年）行政数据。我们依靠生存回归分析来确定项目规模、治疗启动（等待时间）和参与（留存率和完成率）与任何给定年份服务中断之间的关联。我们研究了扩张前后中断服务与持续服务项目之间的差异。
在2006年至2014年期间，62%的项目在某个时间点中断了服务。项目规模和治疗留存率与服务中断风险呈负相关。女性客户比例也与服务中断风险呈负相关。与住院项目相比，美沙酮项目中断服务的可能性降低。有两个交互作用显著；项目规模与留存率以及项目规模与完成率均与服务中断风险呈负相关。
项目规模（大）、类型（美沙酮）、绩效（留存）和客户群体（女性）与该药物治疗系统的稳定性相关。由于该系统中超过70%的项目规模较小，支持它们维持服务的能力对于减少现有的护理可及性差异至关重要。我们讨论了这些发现对系统评估和应对公共卫生危机的意义。
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