title: Ethical disparities: challenges encountered by multidisciplinary providers in fulfilling ethical standards in the care of rural and minority people.
abstract: BACKGROUND
  Health care disparities are well documented for people living in rural areas and for people who are members of ethnic minorities.
  
  
  OBJECTIVE
  Our goal was to determine whether providers report greater difficulty in providing care for rural than urban residents and for ethnic minorities than patients/clients in general in 4 practice areas of ethical relevance: attaining treatment adherence, assuring confidentiality, establishing therapeutic alliance, and engaging in informed consent processes.
  
  
  METHODS
  We received survey responses from 1,558 multidisciplinary medical and behavioral providers across rural and non-rural areas of New Mexico and Alaska in 2004 to assess a wide range of issues in providing health care.
  
  
  RESULTS
  Providers reported some difficulties in fulfilling various ethical practices for all types of patients, but not more difficulty when caring for minority compared to nonminority patients/clients. However, they do report more frequent additional problems related to the practice issues of treatment adherence, therapeutic alliance, informed consent, and confidentiality with minority patients than others. Difficulties and more frequent additional problems are greater for providers in rural than in non-rural areas. Results generalize across both Alaska and New Mexico with few differences.
  
  
  CONCLUSIONS
  We obtained evidence for disparity in care for patients/ clients who were minority group members, and clear evidence of disparity for people residing in rural compared to non-rural areas of 2 states with large rural areas.
authors.affiliation: Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee 53226, USA. RobertsL@mcw.edu
authors.forename: Laura Weiss
authors.initials: LW
authors.lastname: Roberts
authors.forename: Mark E
authors.initials: ME
authors.lastname: Johnson
authors.forename: Christiane
authors.initials: C
authors.lastname: Brems
authors.forename: Teddy D
authors.initials: TD
authors.lastname: Warner
mesh_terms: D000328:Adult; D000413:Alaska; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000941:ethics*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D009516:New Mexico; D012424:Rural Population; D019966:Substance-Related Disorders / Q000628:therapy