Rural healthcare delivery: Navigating a complex ecosystem

Abstract

Clinical Practice Guidelines (CPGs) provide evidence-based recommendations for Healthcare Providers (HCPs) to utilize when making patient care decisions. Rural providers face challenges in the provision of evidence-based care, including the use of guidelines. The aim of this article is to explore the complexities of providing healthcare in rural areas. This article will focus on a specific aspect of rural maternity care with well-established CPGs, the prevention of Rhesus D factor alloimmunization. An applied health research approach, interpretive description, utilized semistructured interviews with HCPs across the vast geographic region of northern British Columbia. The study found that HCPs are aware of guidelines but face various barriers during implementation. In order to implement guidelines within practice, rural HCPs adapt processes to overcome local barriers. These process adaptations need to be identified and shared across a large health authority with a complex geography and healthcare system to ensure quality of care.

What a Pandemic Has Taught Us About the Potential for Innovation in Rural Health: Commencing an Ethnography in Canada, the United States, Sweden, and Australia

“…The ability for local health and care services to act somewhat autonomously in responding to health risk events like the pandemic should be seen as a critical part of socially responsible and community-based care paradigms (6)(7)(8). These paradigms emphasize the need for services to understand the communities in which they operate and to tailor what they do to the needs of those communities (1). Given the diversity of rural communities (9), this means that services in even relatively proximate communities could and should operate differently to one another.…”

“…The geographical context for the research was central to its undertaking. Our research interest has long been in understanding how health services operate in small rural settings, where service sustainability is challenged by relatively small population sizes (the largest towns within a functional service area having fewer than 5,000–7,000 inhabitants) and intermediate distances to larger service centres ( 1 , 2 ). By intermediate distances we mean that larger centres are accessible by road without necessitating (although they often do involve) overnight stays, but not daily.…”