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Szumer RTO, Arnold M. The Ethics of Overlapping Relationships in Rural and Remote Healthcare. A Narrative Review. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:181-190. [PMID: 36976435 PMCID: PMC10352392 DOI: 10.1007/s11673-023-10243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/06/2022] [Indexed: 06/18/2023]
Abstract
It is presently unclear whether a distinct "rural ethics" of navigating professional boundaries exists, and if so, what theoretical approaches may assist practitioners to manage overlapping relationships. To be effective clinicians while concurrently partaking in community life, practitioners must develop and maintain safe, ethical, and sustainable therapeutic relationships in rural and remote healthcare. A narrative review was conducted identifying a significant body of qualitative and theoretical literature which explores the pervasiveness of dual relationships for practitioners working in rural and remote healthcare. Rather than viewing dual relationships as ethically unacceptable, much contemporary work focusses on the lived experiences of healthcare workers and explores what approaches may be available that both protect the therapeutic relationship while recognizing the unique nature of rural and remote healthcare practice. We conclude that practitioners must have a means of operating within a contextually informed ethics of professional boundaries. Drawing on pre-existing work, one schema is proposed that could form the basis for further engagement through interactive teaching sessions, professional development, mentoring, or guidelines.
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Affiliation(s)
- Rafael Thomas Osik Szumer
- School of Rural Health (Dubbo/Orange), Faculty of Medicine and Health, The University of Sydney, Dubbo, NSW, Australia
| | - Mark Arnold
- School of Rural Health (Dubbo/Orange), Faculty of Medicine and Health, The University of Sydney, Dubbo, NSW, Australia.
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Balsom CR, Farrell A, Kelly DV. Barriers and enablers to testing for hepatitis C virus infection in people who inject drugs - a scoping review of the qualitative evidence. BMC Public Health 2023; 23:1038. [PMID: 37259073 DOI: 10.1186/s12889-023-16017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/30/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Injection drug use is the primary mode of transmission of hepatitis C virus (HCV) infection in the developed world and guidelines recommend screening individuals with current or history of injection drug use for HCV; however, the majority of those living with HCV in Canada are not aware of their positive status. This low level of HCV status awareness suggests that screening is not effective with current testing strategies. The aim of this review is to determine what barriers and enablers people who inject drugs (PWID) experience surrounding testing for HCV to help inform the development of an engaging testing strategy. METHODS Comprehensive literature searches were conducted using Medline, Embase and CINAHL in February 2021. Included studies investigated the barriers and enablers to testing for HCV in PWID and the experiences of PWID in testing for HCV. Studies were included if they were qualitative or mixed-methods design, involved people with current injection drug use or those with a history of injecting drugs, and were written in the English language. Studies were compared and common themes were coded and analyzed. RESULTS The literature search resulted in 1554 citations and ultimately nine studies were included. Common barriers included self-perception of low risk for HCV, fear of diagnosis, stigma associated with IV drug use and HCV, antipathy in relation to mainstream health care services, limited knowledge about HCV, lack of rapport with provider, lack of motivation or competing priority of drug use, and limited awareness of new treatment options. Common enablers to testing included increasing awareness of HCV testing and treatment and providing positive narratives around HCV care, positive rapport with provider, accessible testing options and individualized care. CONCLUSION While there has been some qualitative research on barriers and enablers to testing for HCV in PWID more research is needed to focus on this research question as a primary objective in order to provide more understanding from the participant's perspective.
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Affiliation(s)
- Cathy R Balsom
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada.
| | - Alison Farrell
- Health Sciences Library, Memorial University of Newfoundland, St. John's, Canada
| | - Deborah V Kelly
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada
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Roberts LW. Recognizing Rural Health Resource and Education Needs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1251-1253. [PMID: 36098770 DOI: 10.1097/acm.0000000000004823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Bravo M, Lim R, Poonai N, Chen B. Clinical Suspicion and Language Translation in the Pediatric Emergency Department. Pediatr Emerg Care 2021; 37:e272-e274. [PMID: 30130342 DOI: 10.1097/pec.0000000000001606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ABSTRACT Elucidating a medical history and gaining patient consent and buy-in are difficult in any teenager presenting to a North American pediatric emergency department, but especially so when they present with limited English fluency. Translators can make this process easier, but both limited availability and impreciseness in translation can reduce their utility. We describe 2 teenage females who presented to our pediatric emergency department within 48 hours with similar presentations but no obvious organic cause or examination findings to suggest a specific diagnosis. We demonstrate how complex language translation issues in these adolescents contributed to prolonged diagnoses and advocate for independent interpreters to be available on first presentation to hospital.
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Affiliation(s)
| | - Rodrick Lim
- Pediatrics and Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Naveen Poonai
- Pediatrics and Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Amiri S, McDonell MG, Denney JT, Buchwald D, Amram O. Disparities in Access to Opioid Treatment Programs and Office-Based Buprenorphine Treatment Across the Rural-Urban and Area Deprivation Continua: A US Nationwide Small Area Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:188-195. [PMID: 33518025 DOI: 10.1016/j.jval.2020.08.2098] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To measure access to opioid treatment programs (OTPs) and office-based buprenorphine treatment (OBBTs) at the smallest geographic unit for which the Census Bureau publishes demographic and socioeconomic data (ie, block group) and to explore disparities in access to treatment across the rural-urban and area deprivation continua across the United States. METHODS Access to OTPs and OBBTs at the block group in 2019 was quantified using an innovative 2-step floating catchment area technique that accounts for the supply of treatment facilities relative to the population size, proximity of facilities relative to the location of population in block groups, and time as a barrier within catchments. Block groups were stratified into tertiles based on the rural-urban continuum codes (metropolitan, micropolitan, small town, or rural) and area deprivation index (least-deprived, middle-deprived, most-deprived). The Integrated Nested Laplace Approximation approach was used for statistical analysis. RESULTS Across the United States, 3329 block groups corresponding to 2 915 949 adults lacked access to OTPs within a 2-hour drive of their community and 130 block groups corresponding to 86 605 adults did not have access to OBBTs. Disparities in access to treatment were observed across the urban-rural and area deprivation continua including (1) lowest mean access score to OBBTs were found among most-deprived small towns, and (2) lower mean access score to OTPs were found among micropolitan and small towns. CONCLUSIONS The results of this study revealed disparities in access to medication-assisted treatment. The findings call for creative initiatives and local and regional policies to develop to mitigate access problems.
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Affiliation(s)
- Solmaz Amiri
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
| | - Michael G McDonell
- Behavioral Health Innovations, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Justin T Denney
- Department of Sociology, Washington State University, Pullman, WA, USA
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
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Hammack-Aviran CM, Brelsford KM, McKenna KC, Graham RD, Lampron ZM, Beskow LM. Research Use of Electronic Health Records: Patients' Views on Alternative Approaches to Permission. AJOB Empir Bioeth 2020; 11:172-186. [PMID: 32338567 DOI: 10.1080/23294515.2020.1755383] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: The increased use of electronic health records (EHRs) has resulted in new opportunities for research, but also raises concerns regarding privacy, confidentiality, and patient awareness. Because public trust is essential to the success of the research enterprise, patient perspectives are essential to the development and implementation of ethical approaches to the research use of EHRs. Yet, little is known about patients' views and expectations regarding various approaches to seeking permission for research use of their EHR data. Methods: We conducted semi-structured interviews with 120 patients in four counties in diverse regions of the southeastern United States: Appalachia, the Mississippi Delta, and the Piedmont area of North Carolina. We asked participants to consider, from multiple stakeholder perspectives, the advantages and disadvantages of three approaches to notifying patients of, or obtaining permission for, research use of their EHR data; whether they believed it would be acceptable if their healthcare organization used each approach; and which approach would be most appropriate. Results: Nearly all participants said General Notification, Broad Permission, and Categorical Permission would each be acceptable approaches to notification of, or permission for, EHR research. Over half identified Broad Permission as the most appropriate approach. Across all of these discussions, major themes included the importance of clarity, simplicity, and usability of patient-facing materials, as well as the level of transparency, trustworthiness, and respect for patients the approach conveys. Conclusions: Our findings help to inform the development and implementation of ethical approaches to the research use of EHRs by identifying key patient considerations regarding various approaches to permission and suggesting potential actions for healthcare organizations and researchers.
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Affiliation(s)
- Catherine M Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathleen M Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin C McKenna
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ross D Graham
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zachary M Lampron
- Department of Pragmatic Health Systems Research, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Alzghoul MM, Jones-Bonofiglio K. Nurses' tension-based ethical decision making in rural acute care settings. Nurs Ethics 2020; 27:1032-1043. [PMID: 32223495 DOI: 10.1177/0969733020906594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nurses in acute care are frequently involved in ethical decision making and experience a higher prevalence of ethical conflicts and dilemmas. Nurses in underresourced rural acute care settings also are likely to face unique ethical challenges. However, rarely have the particular contexts of these experiences in rural acute care settings been researched. A culture of silence and fear in small towns has made exploring these issues difficult. OBJECTIVES To explore registered nurses' experiences of ethical issues and ethical decision making in rural acute care hospitals in northern Ontario, Canada. RESEARCH DESIGN Guided by an interpretive descriptive approach, data were collected by two nurse researchers using in-depth, individual, and semistructured telephone interviews. Data were managed with NVivo v.11 and analyzed using inductive, comparative, thematic analyses. PARTICIPANTS AND RESEARCH CONTEXT The participants were eight registered nurses working in two acute care hospitals in northern Ontario. ETHICAL CONSIDERATIONS Ethical protocols were followed in accordance with ethics approval from the researchers' university and the hospitals. FINDINGS Results identified four themes that culminated in the development of a quadruple helix ethical decision-making framework of power, trust, care, and fear. DISCUSSION AND CONCLUSION The participants described complex ethical conflicts and dilemmas in acute care settings that were influenced by the context of working and living in small rural communities in northern Ontario. Nurses described navigating ethics in practice using a tension-based approach to ethical decision making, needing to carry these issues silently and often having no resolution to ethical challenges. These findings have important implications for nursing education, research, and practice. Nurses need safe spaces, formal ethics support, and improved access to resources. Additional ethics education and training specific to the unique contexts of rural settings are needed.
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Saunders EC, Moore SK, Gardner T, Farkas S, Marsch LA, McLeman B, Meier A, Nesin N, Rotrosen J, Walsh O, McNeely J. Screening for Substance Use in Rural Primary Care: a Qualitative Study of Providers and Patients. J Gen Intern Med 2019; 34:2824-2832. [PMID: 31414355 PMCID: PMC6854168 DOI: 10.1007/s11606-019-05232-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Substance use frequently goes undetected in primary care. Though barriers to implementing systematic screening for alcohol and drug use have been examined in urban settings, less is known about screening in rural primary care. OBJECTIVE To identify current screening practices, barriers, facilitators, and recommendations for the implementation of substance use screening in rural federally qualified health centers (FQHCs). DESIGN As part of a multi-phase study implementing electronic health record-integrated screening, focus groups (n = 60: all stakeholder groups) and individual interviews (n = 10 primary care providers (PCPs)) were conducted. PARTICIPANTS Three stakeholder groups (PCPs, medical assistants (MAs), and patients) at three rural FQHCs in Maine. APPROACH Focus groups and interviews were recorded, transcribed, and content analyzed. Themes surrounding current substance use screening practices, barriers to screening, and recommendations for implementation were identified and organized by the Knowledge to Action (KTA) Framework. KEY RESULTS Identifying the problem: Stakeholders unanimously agreed that screening is important, and that universal screening is preferred to targeted approaches. Adapting to the local context: PCPs and MAs agreed that screening should be done annually. Views were mixed regarding the delivery of screening; patients preferred self-administered, tablet-based screening, while MAs and PCPs were divided between self-administered and face-to-face approaches. Assessing barriers: For patients, barriers to screening centered around a perceived lack of rapport with providers, which contributed to concerns about trust, judgment, and privacy. For PCPs and MAs, barriers included lack of comfort, training, and preparedness to address screening results and offer treatment. CONCLUSIONS Though stakeholders agree on the importance of implementing universal screening, concerns about the patient-provider relationship, the consequences of disclosure, and privacy appear heightened by the rural context. Findings highlight that strong relationships with providers are critical for patients, while in-clinic resources and training are needed to increase provider comfort and preparedness to address substance use.
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Affiliation(s)
- Elizabeth C Saunders
- The Dartmouth Institute (TDI) for Health Policy and Clinical Practice, Lebanon, NH, USA.
| | - Sarah K Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Trip Gardner
- Penobscot Community Health Care (PCHC), Bangor, ME, USA
| | - Sarah Farkas
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Andrea Meier
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Noah Nesin
- Penobscot Community Health Care (PCHC), Bangor, ME, USA
| | - John Rotrosen
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Olivia Walsh
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Jennifer McNeely
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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Johansson P, Schober D, Tutsch SF, Brueggeman G, Leon M, Lyden E, Schulz PS, Estabrooks P, Zimmerman L. Adapting an Evidence-based Cardiovascular Disease Risk Reduction Intervention to Rural Communities. J Rural Health 2019; 35:87-96. [PMID: 29888458 DOI: 10.1111/jrh.12306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Using the RE-AIM framework, the primary purpose of this qualitative study was to assess focus group data to generate information on the applicability of an evidence-based cardiovascular disease (CVD) risk intervention developed for an urban setting for rural areas in Nebraska. We also sought to determine potential adaptations that may be necessary to implement the study in a rural setting. The CVD risk reduction intervention is based on the Community Outreach and Cardiovascular Health (COACH) program, which included nurse practitioner/community health worker teams. METHODS This qualitative study involved conducting 3 focus groups with patients with CVD risk factors to assess community readiness for participating in the intervention, the mode of the delivery of the intervention, the setting of the intervention, program content, and raising awareness of the intervention. FINDINGS Findings from the focus groups indicate acceptability toward a CVD risk reduction program modeled after the COACH. Participants favored initial in-person face-to-face interactions with a nurse practitioner that could transition to phone-based meetings and Skype. In addition, participants underscored that confidentiality can be a concern in small communities and therefore community health workers need to be trusted individuals. Calls for additions to COACH materials were very specific and participants underscored the need for social support. CONCLUSIONS With minor adaptations, the COACH program can be pilot tested in rural settings to address key health concerns and behaviors that affect risk for cardiovascular health.
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Affiliation(s)
- Patrik Johansson
- Rural Health Education Network, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Sonja Franziska Tutsch
- Rural Health Education Network, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Grant Brueggeman
- Rural Health Education Network, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Melissa Leon
- Rural Health Education Network, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth Lyden
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paula Sue Schulz
- College of Nursing - Lincoln Division, University of Nebraska Medical Center, Lincoln, Nebraska
| | - Paul Estabrooks
- Rural Health Education Network, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Lani Zimmerman
- College of Nursing - Lincoln Division, University of Nebraska Medical Center, Lincoln, Nebraska
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Lehman BJ, David DM, Gruber JA. Rethinking the biopsychosocial model of health: Understanding health as a dynamic system. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2017. [DOI: 10.1111/spc3.12328] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lin SW, Yen CF, Chiu TY, Chi WC, Liou TH. New indices for home nursing care resource disparities in rural and urban areas, based on geocoding and geographic distance barriers: a cross-sectional study. Int J Health Geogr 2015; 14:28. [PMID: 26449322 PMCID: PMC4598966 DOI: 10.1186/s12942-015-0021-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 09/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aging in place is the crucial object of long-term care policy worldwide. Approximately 15.6-19.4% of people aged 15 or above live with a disability, and 15.3% of them have moderate or severe disabilities. The allocation of home nursing care services is therefore an important issue. Service providers in Taiwan vary substantially across regions, and between rural and urban areas. There are no appropriate indices for describing the capacity of providers that it is due to the distances from care recipients. This study therefore aimed to describe and compare distance barriers for home nursing care providers using indices of the "profit willing distance" and the "tolerance limited distance". METHODS This cross-sectional study was conducted during 2012 and 2013 using geocoding and a geographic information system to identify the distance from the providers' locations to participants' homes in urban (Taipei City) and rural (Hualien County) areas in Taiwan. Data were collected in-person by professionals in Taiwanese hospitals using the World Health Organization Disability Assessment Schedule 2.0. The indices were calculated using regression curves, and the first inflection points were determined as the points on the curves where the first and second derivatives equaled 0. RESULTS There were 5627 participants from urban areas and 956 from rural areas. In urban areas, the profit willing distance was 550-600 m, and we were unable to identify them in rural areas. This demonstrates that providers may need to supply services even when there is little profit. The tolerance limited distance were 1600-1650 m in urban areas and 1950-2000 m in rural areas. In rural areas, 33.3% of those living inside the tolerance limited distance and there was no provider within this distance, but this figure fell to just 13.9% in urban areas. There were strong disparities between urban and rural areas in home nursing care resource allocation. CONCLUSIONS Our new "profit willing distance" and the "tolerance limited distance" are considered to be clearer and more equitable than other evaluation indices. They have practical application in considering resource distribution issues around the world, and in particular the rural-urban disparities for public resource.
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Affiliation(s)
- Shyang-Woei Lin
- Department of Natural Resources and Environmental Studies, National Dong Hwa University, Hualien, Taiwan.
| | - Chia-Feng Yen
- Department of Public Health, Buddhist Tzu-Chi University, Hualien, Taiwan.
| | - Tzu-Ying Chiu
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
| | - Wen-Chou Chi
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan.
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan. .,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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Hauenstein EJ, Glick DF, Kane C, Kulbok P, Barbero E, Cox K. A Model to Develop Nurse Leaders for Rural Practice. J Prof Nurs 2014; 30:463-73. [DOI: 10.1016/j.profnurs.2014.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Indexed: 12/29/2022]
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Chen Y, Yin Z, Xie Q. Suggestions to ameliorate the inequity in urban/rural allocation of healthcare resources in China. Int J Equity Health 2014; 13:34. [PMID: 24884614 PMCID: PMC4016733 DOI: 10.1186/1475-9276-13-34] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/28/2014] [Indexed: 11/30/2022] Open
Abstract
The imbalance in the allocation in healthcare resources between urban and rural areas has become a main focus of the recent medical reforms adopted in China. However, systematic analysis has identified wide differences in the allocation of healthcare resources between urban and rural areas, including healthcare expenditures and the number of healthcare facilities, available beds, and personnel. Therefore, the aim of this report was to identify ethical considerations in current governmental policies to rectify existing problems in the distribution of healthcare resources. Our findings indicate that the inequality in the distribution of healthcare resources does not adhere to ethical standards and the policies are flawed because they give rise to differences in the availability of medical care to urban and rural communities. To optimize the allocation of medical healthcare resources, countermeasures are proposed to formulate policies to urge the flow of public healthcare resources to rural areas, strengthen the responsibilities of both governmental and public financial investments, increase the construction of public healthcare facilities in rural areas, promote the quality of healthcare resources, adjust resource allocations to rural public healthcare facilities, and improve resource utilization efficiency by establishing two-way referral mechanisms.
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Affiliation(s)
| | | | - Qiong Xie
- The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qing Chun Road, Shang Cheng District, Hangzhou 310003, Zhejiang Province, China.
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Chuang CH, Hwang SW, McCall-Hosenfeld JS, Rosenwasser L, Hillemeier MM, Weisman CS. Primary care physicians' perceptions of barriers to preventive reproductive health care in rural communities. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2012; 44:78-83. [PMID: 22681422 PMCID: PMC3706998 DOI: 10.1363/4407812] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
CONTEXT Women residing in rural areas are less likely than urban women to receive preventive reproductive health care, but reasons for this disparity remain largely unexplored. METHODS In 2010, semistructured interviews were conducted with 19 rural primary care physicians in central Pennsylvania regarding their experiences in two domains of preventive reproductive health-contraceptive care and preconception care. Major themes were identified using a modified grounded theory approach. RESULTS Physicians perceived that they had a greater role in providing contraceptive care than did nonrural physicians and that contraceptives were widely accessible to patients in their communities; however, the scope of contraceptive services they provided varied widely. Participants were aware of the importance of optimal health prior to pregnancy, but most did not routinely initiate preconception counseling. Physicians perceived rural community norms of unintended pregnancies, large families, and indifference toward career and educational goals for young women as the biggest barriers to both contraceptive and preconception care, as these attitudes resulted in a lack of patient interest in family planning. Lack of time and resources were identified as additional barriers to providing preconception care. CONCLUSIONS Rural women's low use of contraceptive and preconception care services may reflect that preventive reproductive health care is not a priority in rural communities, rather than that it is inaccessible. Efforts to motivate rural women to engage in reproductive life planning, including more proactive counseling by providers, merit examination as ways to improve use of services.
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Affiliation(s)
- Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA.
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Access to emerging technologies and telehealth intervention modality preferences in rural patients. HEALTH AND TECHNOLOGY 2011. [DOI: 10.1007/s12553-011-0009-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Chipp C, Dewane S, Brems C, Johnson ME, Warner TD, Roberts LW. "If only someone had told me…": lessons from rural providers. J Rural Health 2011; 27:122-30. [PMID: 21204979 DOI: 10.1111/j.1748-0361.2010.00314.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Health care providers face challenges in rural service delivery due to the unique circumstances of rural living. The intersection of rural living and health care challenges can create barriers to care that providers may not be trained to navigate, resulting in burnout and high turnover. Through the exploration of experienced rural providers' knowledge and lessons learned, this study sought to inform future practitioners, educators, and policy makers in avenues through which to enhance training, recruiting, and maintaining a rural workforce across multiple health care domains. METHODS Using a qualitative study design, 18 focus groups were conducted, with a total of 127 health care providers from Alaska and New Mexico. Transcribed responses from the question, "What are the 3 things you wish someone would have told you about delivering health care in rural areas?" were thematically coded. FINDINGS Emergent themes coalesced into 3 overarching themes addressing practice-related factors surrounding the challenges, adaptations, and rewards of being a rural practitioner. CONCLUSION Based on the themes, a series of recommendations are offered to future rural practitioners related to community engagement, service delivery, and burnout prevention. The recommendations offered may help practitioners enter communities more respectfully and competently. They can also be used by training programs and communities to develop supportive programs for new practitioners, enabling them to retain their services, and help practitioners integrate into the community. Moving toward an integrative paradigm of health care delivery wherein practitioners and communities collaborate in service delivery will be the key to enhancing rural health care and reducing disparities.
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Affiliation(s)
- Cody Chipp
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, Alaska 99508, USA
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Abstract
The rural health context in the United States presents unique ethical challenges to its approximately 60 million residents, who represent about one quarter of the overall population and are distributed over three-quarters of the country’s land mass. The rural context is not only identified by the small population density and distance to an urban setting but also by a combination of social, religious, geographical, and cultural factors. Living in a rural setting fosters a sense of shared values and beliefs, a strong work ethic, self-reliance, and a tendency for close-knit extended social structures where overlapping relationships are commonplace.
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Curtis AC, Waters CM, Brindis C. Rural Adolescent Health: The Importance of Prevention Services in the Rural Community. J Rural Health 2010; 27:60-71. [DOI: 10.1111/j.1748-0361.2010.00319.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Allott K, Lloyd S. The Provision of Neuropsychological Services in Rural/Regional Settings: Professional and Ethical Issues. ACTA ACUST UNITED AC 2009; 16:193-206. [DOI: 10.1080/09084280903098760] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Snow N, Austin WJ. Community treatment orders: the ethical balancing act in community mental health. J Psychiatr Ment Health Nurs 2009; 16:177-86. [PMID: 19281549 DOI: 10.1111/j.1365-2850.2008.01363.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Community treatment orders (CTOs) are legal mechanisms by which an individual with a mental illness and a history of non-compliance and potential for violence can be mandated (against their will) to undergo psychiatric treatment in an outpatient setting. Although CTOs are increasingly being adopted by governments as a means of protecting both mentally ill persons and society itself, their use continues to stimulate considerable debate. While there is some evidence of their potential benefits in promoting treatment compliance and reducing hospital stays, there is concern that they infringe on the mental health client's human rights and freedoms. Consideration of the ethical and practical implications of the use of CTOs must continue. In this paper, some of the most pressing issues are identified and discussed.
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Affiliation(s)
- N Snow
- University of Alberta, Faculty, Centre for Nursing Studies, St. John's, NL, Canada.
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Collaborative Mental Health Care in Rural and Isolated Canada: Stakeholder Feedback. J Psychosoc Nurs Ment Health Serv 2007; 45:37-45. [DOI: 10.3928/02793695-20071201-08] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rueter MA, Holm KE, Burzette R, Kim KJ, Conger RD. Mental health of rural young adults: prevalence of psychiatric disorders, comorbidity, and service utilization. Community Ment Health J 2007; 43:229-49. [PMID: 17345147 DOI: 10.1007/s10597-007-9082-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 01/02/2007] [Indexed: 10/23/2022]
Abstract
Few studies estimate rural psychiatric disorder rates. No study has reported either DSM-III-R or DSM IV disorder prevalence and mental health service use among US rural young adults. This paper reports psychiatric disorder prevalence, comorbidity, service utilization, and disorder correlates in a community sample of 536 young adults, aged 19 to 23 years, living in the rural Midwestern US. More than 60% of the sample met criteria for a lifetime disorder. Substance use disorders were most prevalent. Results indicate that young adults living in the rural Midwest demonstrate substantial rates of psychiatric disorder that are comparable to other population groups.
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Affiliation(s)
- Martha A Rueter
- Department of Family Social Science, University of Minnesota, 290 McNeal Hall, 1985 Buford Hall, St. Paul, MN 55108, USA.
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Brems C, Johnson ME, Warner TD, Roberts LW. Exploring differences in caseloads of rural and urban healthcare providers in Alaska and New Mexico. Public Health 2006; 121:3-17. [PMID: 17169386 DOI: 10.1016/j.puhe.2006.07.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 06/22/2006] [Accepted: 07/19/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Although it is commonly accepted that rural healthcare providers face demands that are both qualitatively and quantitatively different from those faced by urban providers, this conclusion is based largely on data from healthcare consumers and relies on qualitative work with small sample sizes, surveys with small sample sizes, theoretical reviews and anecdotal reports. To enhance our knowledge of the demands faced by rural healthcare providers and to gain the perspectives of healthcare providers themselves, this study explored the caseloads of rural providers compared with those of urban providers. METHOD An extensive survey of over 1500 licensed clinicians across eight physical and behavioural healthcare provider groups in Alaska and New Mexico was undertaken to explore differences in caseloads based on community size (small rural, rural, small urban, urban), state (Alaska, New Mexico) and discipline (health, behavioural). RESULTS Findings indicated numerous caseload differences between community sizes that were consistent across both states, with complex case presentations being described most commonly by small rural and rural providers. Substance abuse, alcohol use, cultural diversity, economic disadvantage and age diversity were issues faced more often by providers in rural and small rural communities than by providers in small urban and urban communities. Rural, but not small rural, providers faced challenges around work with prisoners and individuals needing involuntary hospitalization. Although some state and discipline differences were noted, the most important findings were based on community size. CONCLUSIONS The findings of this study have important implications for provider preparation and training, future research, tailored resource allocation, public health policy, and efforts to prevent 'burnout' of rural providers.
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Austin W, Bergum V, Nuttgens S, Peternelj-Taylor C. A Re-Visioning of Boundaries in Professional Helping Relationships: Exploring Other Metaphors. ETHICS & BEHAVIOR 2006. [DOI: 10.1207/s15327019eb1602_1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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