Advisor(s)
Geoffrey Silvera
Committee Member(s)
Christy Lemak
Karen Cropsey
Larry Hearld
School
School of Health Professions
Document Type
Dissertation
Department (new version)
Administration/Health Services
Date of Award
9-11-2025
Degree Name by School
Executive Doctor of Science (DSc) School of Health Professions
Abstract
Substance use disorder (SUD) remains a public health concern in the United States. Low-income and underserved populations continue to face barriers to accessing effective treatment. The rapid expansion of telehealth has been proposed as a solution to barriers such as geographic distance and transportation. However, it is unclear whether telehealth effectively addresses these barriers or how access-related factors influence treatment outcomes across care modalities. This retrospective cohort study, guided by the Social Determinants of Health (SDOH) framework, evaluated the impact of treatment modality, transportation access, and geographic distance on retention and completion in a publicly funded Intensive Outpatient Program (IOP) for SUD. The analysis also tested whether treatment modality moderated the effects of transportation access and geographic distance on these outcomes. Of 564 patient records reviewed, the final sample included 407 adults after applying study criteria and excluding missing data. Two distinct, non-overlapping cohorts were analyzed: adults who received in-person treatment between March 2019 and January 2020 and those who received telehealth between October 2020 and August 2021. Retention (days in treatment) and program completion were evaluated using multivariate linear and logistic regression models, controlling for demographic, socioeconomic, and clinical factors. Moderation was tested with interaction terms. In adjusted models, telehealth was associated with significantly lower retention compared to in-person care (B = -85.01, p < .001) but was not a significant predictor of program completion (OR = 0.89, p = .729). Transportation access and geographic distance were not significant predictors of retention or completion. Older age (OR = 1.03, p = .004) and court referral (OR = 2.05, p = .010) were associated with higher odds of completion. Opioid use disorder diagnosis (OR = 0.34, p < .001) and Black race (OR = 0.47, p = .005) were associated with lower odds of completion. No significant moderation effects were observed. These findings suggest that while telehealth reduces certain barriers, it does not uniformly improve retention or completion in SUD care. Addressing broader social determinants and tailoring interventions to individual needs remain essential for promoting equitable and effective SUD treatment. Keywords: Social Determinants of Health, retention, completion, substance use disorder, telehealth
ProQuest ID
Recommended Citation
Morgan, Yasemin Tanik, "Influence Of Transportation Access And Geographic Distance On Retention And Completion In Substance Use Treatment: A Retrospective Study Of In-Person And Telehealth Modalities" (2025). All ETDs from UAB. 7425.
https://digitalcommons.library.uab.edu/etd-collection/7425
