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Ethics Forum: Mitigation Tips for Health Disparities Among Rural & Indigenous Peoples

Laura Nichols, MD, Lee Graham, MD, & Erdal Diri, MD  |  Issue: October 2023  |  October 12, 2023


Laura Nichols, MD, practices internal medicine at Sanford Health, Fargo, N.D.

Lee Graham, MD, is a rheumatology specialist, retired from his practice in Westmont, Ill.

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Erdal Diri, MD, is a clinical associate professor of medicine at the University of North Dakota, Fargo.

Acknowledgments

The authors thank Anne Bass, MD, for her invaluable support as the chair of the ACR Committee on Ethics and in her shepherding role for this article. Special thanks are also due to the dedicated members of the Ethics Committee for their insightful feedback during the drafting process.

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References

  1. How to improve health care in rural areas [blog]. Tulane University. 2023 Jan 17.
  2. Battafarano DF, Ditmyer M, Bolster MB, et al. 2015 American College of Rheumatology workforce study: Supply and demand projections of adult rheumatology workforce, 2015-2030. Arthritis Care Res. 2018;70(4):617–626.
  3. Lennep DS, Crout T, Majithia V. Rural health issues in rheumatology: A review. Curr Opin Rheumatol. 2020 Mar;32(2):119–125.
  4. Fourteenth Broadband Deployment Report. Federal Communications Commission. 2021 Jan 19. https://docs.fcc.gov/public/attachments/FCC-21-18A1.pdf.
  5. Health disparities. Centers for Disease Prevention and Control. 2023 May 26. https://www.cdc.gov/healthyyouth/disparities/index.htm.
  6. Hitchon CA, ONeil L, Peschken CA, et al. Disparities in rheumatoid arthritis outcomes for North American Indigenous populations. Int J Circumpolar Health. 2023 Dec;82(1):2166447.
  7. Peschken CA, Esdaile JM. Rheumatic diseases in North America’s Indigenous peoples. Semin Arthritis Rheum. 1999 Jun;28(6):368–391.
  8. Mandal J, Carroway T, Izadi Z, et al. The rheumatology access expansion (RAE) initiative: Improving rheumatoid arthritis care on Navajo nation through primary care provider education (poster 0005). Arthritis Rheumatol. 2022;74(suppl 9).
  9. Hasan B, Fike A, Hasni S. Health disparities in systemic lupus erythematosus-a narrative review. Clin Rheumatol. 2022 Nov;41(11):3299–3311.
  10. Jackson LE, Edgil TA, Hill B, et al. Telemedicine in rheumatology care: A systematic review. Semin Arthritis Rheum. 2022 Oct;56:152045.
  11. American College of Rheumatology Position Statement on Telemedicine. American College of Rheumatology. 2020 Jun 29. https://assets.contentstack.io/v3/assets/bltee37abb6b278ab2c/blt0c00d75c71e0ae20/acr-position-statement-telemedicine.pdf.
  12. Qaseem A, MacLean CH, Tierney S, et al. Performance measures for physicians providing clinical care using telemedicine: A position paper from the American College of Physicians. Ann Intern Med. 2023;176(5):694–698.
  13. Jackson LE, Danila MI. Healthcare disparities in telemedicine for rheumatology care. Curr Opin Rheumatol. 2022 May 1;34(3):171–178.
  14. Fillon M. Patients help themselves: Program evolves from community based participatory research. The Rheumatologist. 2020 Feb;14(2):38.
  15. Community health workers in tribal communities. Rural Health Information Hub. 2011 Sep 1. Updated 2020 Sep 8. https://www.ruralhealthinfo.org/toolkits/community-health-workers/4/adapting-programs/tribal-communities.
  16. Finckh A, Gilbert B, Hodkinson B, et al. Global epidemiology of rheumatoid arthritis. Nat Rev Rheumatol. 2022 Oct;18(10):591–602.

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Filed under:EthicsGuidancePractice Support Tagged with:DisparitiesEthics Forumhealth disparitiesrural rheumatologytelemedicine

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