RURAL HOSPITAL-BASED ALCOHOL AND CHEMICAL ABUSE SERVICES - AVAILABILITY AND ADOPTION, 1983-1988

Data from a 1983-88 retrospective panel study of 797 rural (non-Metrop olitan Statistical Area) U.S. hospitals revealed that less than one in five (18.7%) had any alcohol and chemical abuse (ACA) service. About one-third of both inpatient and outpatient services had been establish ed during the study period, but few hospitals not offering these servi ces planned to offer them in the immediate future. These findings supp ort other studies that the availability of such services may not meet population need or demand, although non-hospital-sponsored services mi ght partially fill the gap. Bivariate analysis showed that hospital lo cations in counties that were more densely populated, had higher per c apita income and had more physicians per 1,000 population were positiv ely associated with ACA services. Hospitals that were in the New Engla nd, Mid-Atlantic, East North Central census divisions, and were large according to number of beds, presence of psychiatric services, availab ility of psychiatrists and other nonphysician personnel, certain organ izational arrangements and strategic management activities were positi vely associated with ACA services. Multivariable logistic regression s uggested the presence of psychiatric services as a key correlate of AC A services, and the scarcity of psychiatric personnel in rural areas a ppears to have been a major reason for the infrequency of rural hospit al-sponsored ACA services.