title: The effect of individual, program, and neighborhood variables on continuity of treatment among dually diagnosed individuals.
abstract: This study reviewed the medical charts of 271 patients diagnosed with co-morbid mental health and substance-use disorders who were discharged from a hospital acute inpatient unit to various outpatient treatment programs in Philadelphia. Geographic Information Systems (GIS) technology and logistic regression modeling were employed to investigate the effects of individual, neighborhood, and program-level variables on arrival to the first treatment appointment within 30 days of discharge. Four models are presented. The results of the study suggest that having had three or more treatment episodes prior to inpatient hospitalization, and living in a neighborhood in which temporary or transitional, and presumably, other low income housing is located, increased the likelihood of patients continuing with treatment in the community. Discharge to the preadmission address, a chief complaint of bizarre behavior, close proximity of two or more liquor and/or beer stores, a high density of narcotics anonymous (NA) and/or alcoholics anonymous (AA) meetings within the neighborhood, an axis I diagnosis of substance-induced mood disorder, and a urine drug screen positive for heroin reduced the likelihood of attending outpatient treatment. We conclude that geographic and community variables as they relate to substance abuse may add an important dimension to our understanding of patient functioning and well being in the community following inpatient treatment.
authors.affiliation: Department of Geography and Urban Studies, 309 Gladfelter Hall, Temple University (025-27), Philadelphia, PA 19122, USA. jstahler@temple.edu
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Stahler
authors.forename: Silvana
authors.initials: S
authors.lastname: Mazzella
authors.forename: Jeremy
authors.initials: J
authors.lastname: Mennis
authors.forename: Sanjoy
authors.initials: S
authors.lastname: Chakravorty
authors.forename: George
authors.initials: G
authors.lastname: Rengert
authors.forename: Ralph
authors.initials: R
authors.lastname: Spiga
mesh_terms: D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015143:Philadelphia / Q000453:epidemiology; D016730:Program Development; D012111:Residence Characteristics; D012189:Retrospective Studies; D012944:Social Support; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*