title: Ethical matters in rural integrated primary care settings.
abstract: Integrated primary care is particularly valuable to rural communities. Behavioral health care is often in short supply, and small or close-knit communities can intensify the stigma of seeking specialty mental health in rural settings. These and other barriers result in reduced access to needed behavioral health care. Nonetheless, rural practice of integrated primary care presents unique challenges to practitioners of multiple disciplines, including issues of competence, confidentiality, and dual relationships. This article provides an illustrative vignette to describe ethical issues in the rural practice of integrated primary care. It will review discipline-specific guidance in approaching these challenges and will offer recommendations for addressing disparities in the approaches of various disciplines engaged in the practice of integrated primary care.
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester Road, Barre, MA 01005, USA. daniel.mullin@umassmemorial.org
authors.forename: Daniel
authors.initials: D
authors.lastname: Mullin
authors.forename: Joseph
authors.initials: J
authors.lastname: Stenger
mesh_terms: D000368:Aged; D001524:Behavioral Medicine / Q000941:ethics* / Q000458:organization & administration; D017028:Caregivers / Q000941:ethics* / Q000523:psychology; D002983:Clinical Competence; D015897:Comorbidity; D003219:Confidentiality / Q000941:ethics* / Q000592:standards; D001068:Feeding and Eating Disorders / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D033183:Interdisciplinary Communication; D008605:Mental Health Services / Q000600:supply & distribution; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology* / Q000534:rehabilitation; D016584:Panic Disorder / Q000628:therapy; D011320:Primary Health Care / Q000941:ethics* / Q000458:organization & administration; D012017:Referral and Consultation; D019035:Rural Health Services / Q000941:ethics / Q000458:organization & administration; D057545:Social Stigma; D000078329:Workforce