COMMUNITY-BASED FACILITIES MAY BE REPLACING HOSPITALS FOR THE TREATMENT OF ALCOHOLISM - THE EVIDENCE FROM ONTARIO

We examined hospital utilization and use of community facilities for t he treatment of alcohol problems in Ontario using Statistics Canada, H ospital Medical Records Institute records, and other administrative re cords. Between 1974 and 1986 there was a large drop in utilization of hospital services for treatment of alcohol problems. Rates of alcohol inpatient cases in general hospitals dropped by 47% and in mental hosp itals by 33%. At the same time, there was an increase in overall avail ability of hospital beds and bed-days of care for all medical conditio ns, and no change in the total number of hospital discharges (1.3 mill ion) and occupancy rates (80-85%). Also at the same time, the number o f community-based programs for the treatment of alcohol problems incre ased, as did the number of persons or cases treated by them. This was associated with a drop of inpatient cases treated for alcohol problems in 38 out of 48 counties in Ontario (P < .0005). Multiple regression techniques were used to take into account the effect of the slight dec line in overall alcohol consumption in this period. We found that afte r controlling for changes in alcohol consumption, the addition of one community-based alcohol treatment program was associated with a reduct ion in the number of cases treated on a hospital inpatient basis for a lcohol-related problems, with a short-run drop of 27.1 hospital cases within 1 year of a community facility's availability and a long-run re duction of 52.2 cases. (P < .005)