Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts

Abstract

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.

Patient Satisfaction With Medications for Opioid Use Disorder Treatment via Telemedicine: Brief Literature Review and Development of a New Assessment

“…But numerous barriers preclude access to MOUD in rural areas, the most significant of which is the lack of specialized providers able to prescribe MOUD ( 17 ). Rural OUD treatment seekers must often travel long distances and times— a burden that adds to the challenge of accessing and retaining individuals in care ( 12 , 18 , 19 ).…”

A Bridge Too Far? Distance to Waivered Physicians and Utilization of Buprenorphine Treatment for Opioid use Disorder in West Virginia Medicaid

“…People who need to travel farther may have greater difficulty maintaining continuity of care due to the time burden and expenses of travel to physician visits. Travel distance has been shown to be an impediment to continuity of OUD care in prior studies, particularly in rural areas 37 . There are also area-level factors that may influence the relationship between access and quality, including more limited health and social services that support individuals seeking treatment for OUD.…”

“…to be an impediment to continuity of OUD care in prior studies, particularly in rural areas. 37 There are also area-level factors that may influence the relationship between access and quality, including more limited health and social services that support individuals seeking treatment for OUD. We found that most individuals with OUD lived relatively far from waivered physicians-a mean of about 7 miles in metro areas and 15 miles in non-metro areas.…”

Critical access medication for opioid use disorder (MOUD) treatment facilities in the continental United States

“…Geographic dependence is particularly important in light of evidence that proximity exerts a strong impact on treatment adherence and care continuity. Most care-seekers do not wish to travel far to receive care ( Garnick et al., 2020 ; Rosenbaum et al., 2011 ). Critical access MOUD units that service high local demand may face capacity constraints that likewise hinder treatment quality or timeliness ( Bouchery et al., 2015 ).…”