Rural substance use treatment centers in the United States: an assessment of treatment quality by location.
BACKGROUND
While previous research has added to the understanding of rural residents' unique health challenges, much remains to be learned about the provision of substance use disorder (SUD) treatment in rural areas. A key question is difference in structural resources and quality of care between rural and urban treatment centers.


OBJECTIVE
To examine differences in treatment quality in rural and urban centers and to determine if differences in treatment quality are contextualized by centers' structural resources.


METHODS
Utilizing combined data from two representative samples of SUD treatment centers (n = 591), we used a series of multivariate regressions to analyze the association between center rurality and various indicators of structural characteristics and treatment quality. Interaction effects were further examined between structural characteristics and treatment quality indicators.


RESULTS
We found that structural and quality differences between rural and urban treatment centers were present. Rural centers had reduced access to highly educated counselors, were more likely to be non-profit and dependent on public funding, offered fewer wraparound services, and had less diverse specialized treatment options. Our results also indicated that rural centers were less likely to prescribe buprenorphine as part of their treatment but were more likely to employ nursing staff and offer specialized treatment for adolescents. Rural center access to a physician contextualized the association between center rurality and the more limited provision of wraparound services.


CONCLUSIONS
Our findings suggest that treatment quality differs between urban and rural centers in complex ways that are subject to resource availability.
a Owens Institute for Behavioral Research, University of Georgia , Athens , GA , USA.
Mary
M
Bond Edmond
Lydia
L
Aletraris
Paul M
PM
Roman
D006801:Humans; D011785:Quality Assurance, Health Care; D019035:Rural Health Services / Q000592:standards* / Q000706:statistics & numerical data*; D016320:Substance Abuse Treatment Centers / Q000592:standards* / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D019037:Urban Health Services / Q000592:standards / Q000706:statistics & numerical data
Addiction; rural; substance use disorder; treatment quality; urban