Ethical Considerations in Rural Health Care: A Pilot Study of Clinicians in Alaska and New Mexico

Abstract

To investigate differences in the experiences of rural versus non-rural clinicians, we surveyed caregivers in New Mexico and Alaska regarding ethical aspects of care provision. Consistent with past literature, rural compared to non-rural clinicians perceived patients as having less access to health care resources. They reported more interaction with patients and less awkwardness in relationships with their patients outside of work. Rural clinicians also reported their patients expressed more concern about knowing them in both personal and professional roles, had more concerns over confidentiality, and experienced more embarrassment concerning stigmatizing illnesses. Ethical issues and implications of these results for providing care in rural areas are discussed.

Adapting an Evidence‐based Cardiovascular Disease Risk Reduction Intervention to Rural Communities

“…Based on our focus group data we propose the following adaptations to the COACH interventions for rural settings to maximize reach and efficacy: raising community awareness of the role of CHWs prior to implementing a program in rural communities unfamiliar with their role and emphasizing the confidentiality for prospective program participants. As documented in the literature, issues surrounding confidentiality and privacy represent concerns among rural patients and barriers to health care in rural communities . Additional adaptations we propose to maximize reach include having initial face‐to‐face meetings between the NP/CHW team and program participants with the option for transitioning to future phone‐based meetings, having additional examples and explanations regarding strategies to lessen CVD risk in the COACH program guide, addressing geographic distance in rural communities, and having linguistically appropriate services available.…”

Suggestions to ameliorate the inequity in urban/rural allocation of healthcare resources in China

“…Rural residents travel longer distances and have more difficulty in receiving referrals for medical procedures than urban residents, which pose significant barriers to care, particularly for the elderly and children [17,18]. Therefore, a dual referral system is an integrated component in primary healthcare services in rural communities.…”

Mental Health of Rural Young Adults: Prevalence of Psychiatric Disorders, Comorbidity, and Service Utilization

“…The most widely covered issues include barriers to service use (Badger, Robinson, & Farley, 1999;Hartley, Britain, & Sulzbacher, 2002;Hoyt et al, 1997;McCabe & Macnee, 2002;Rost, Fortney, Fischer, & Smith, 2002;Rost, Smith, & Taylor, 1993), modes of service delivery (Badger et al, 1999;Bischoff, Hollist, Smith, & Flack, 2004;Hester, 2004;McCabe & Macnee, 2002), ethical issues related to providing mental health services in small communities (Roberts, Battaglia, & Epstein, 1999;Warner et al, 2005), and characteristics of effective rural mental health service providers (Hovestadt, Fenell, & Canfield, 2002). However, studies of rural mental health have not provided data about the actual rates of service use among young adults with psychiatric disorders who live in rural communities.…”