Geographic accessibility to addiction, mental health, and HIV/AIDS health-care services for opioid-dependent clients
© Denton et al; licensee BioMed Central Ltd. 2015
Published: 20 February 2015
Access to care is an important concept in health policy and health services research, yet it is one which has not been defined precisely. To some researchers “access” refers to entry into or use of a health-care system, while to others it characterizes factors influencing entry or use.  This paper studied accessibility as it refers to entry into or use of a health-care system by measuring geographic accessibility from the location of clients (opioid-dependent individuals) to preventive and treatment facilities for substance use disorders (SUDs), mental health, and HIV/AIDS.
Materials and methods
The study population is opioid-dependent clients (N = 530) screened for an ongoing study of opioid substitution therapy (OST) in Washington, DC. There were three major methodological steps. First, the study geocoded and mapped the spatial distribution of clients’ self-reported neighborhood of residence (algorithmically moved to a nearby location to protect privacy) and health-care facilities specific to their addiction and comorbidities. The facilities included centers for prevention, OST (buprenorphine and methadone), and recovery from SUDs, mental health, STI clinics and HIV/AIDS, harm reduction sites (needle exchanges), and community support (counseling centers, AA, and NA meetings). Second, the study used geostatistical methods to measure accessibility (distance and travel time) from the location of clients to the health-care facilities. Third, the study constructed Addiction Severity Index scores using client questionnaires to measure correlations between opioid users and treatment services.
Often times, it is the individuals with the greatest need for addiction and related health-care services who are the ones with the least geographic accessibility to those services. These findings highlight the need for more careful consideration of geographic accessibility and neighborhood-level contextual barriers in evaluating and planning access to addiction and related health-care services.
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