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Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts
Author(s) -
Garnick Deborah W.,
Horgan Constance M.,
Acevedo Andrea,
Lee Margaret T.,
Panas Lee,
Ritter Grant A.,
Campbell Kevin
Publication year - 2019
Publication title -
the journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.439
H-Index - 57
eISSN - 1748-0361
pISSN - 0890-765X
DOI - 10.1111/jrh.12375
Subject(s) - incentive , substance use , business , medicine , psychiatry , economics , microeconomics
Purpose 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. Methods 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. Findings 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. Conclusions Among rural clients discharged from detoxification and residential treatment, travel time can be an important factor in predicting timely continuity.