Edwards School of Business, University of Saskatchewan, 25 Campus Drive, Saskatoon, SK, S7N 5A7, Canada.
Northern Inter-Tribal Health Authority (NITHA), 2300 10 Ave W., Prince Albert, SK, S6V 5S4, Canada.
J Bioeth Inq. 2023 Jun;20(2):215-223. doi: 10.1007/s11673-023-10233-y. Epub 2023 Feb 16.
Rural, remote, and northern Indigenous communities in Canada frequently face limited access to healthcare services with ongoing physician and staff shortages, inadequate infrastructure, and resource challenges. These healthcare gaps have produced significantly poorer health outcomes for people living in remote communities than those living in southern and urban regions who have timely access to care. Telehealth has played a critical role in bridging long-standing gaps in accessing healthcare services by connecting patients and providers across distance. While the adoption of telehealth in Northern Saskatchewan is growing, its initial implementation faced several barriers related to limited and stretched human and financial resources, infrastructure challenges such as unreliable broadband, and a lack of community involvement and engaged decision-making. Emerging ethical issues during the initial implementation of telehealth in community contexts have been wide ranging including concerns around privacy that have also shaped patients' experiences and particularly the need to consider place and space within rural contexts. Drawing from a qualitative study with four Northern Saskatchewan communities, this paper offers critical perspectives on the resource challenges and place-based considerations that are shaping telehealth in the Saskatchewan context and provides recommendations and lessons learned that could inform other Canadian regions and countries. This work responds to the ethics of tele-healthcare in rural communities in Canada and contributes perspectives of community-based service providers, advisors, and researchers.
加拿大农村、偏远和北部的原住民社区经常面临医疗服务获取受限的问题，存在持续的医生和员工短缺、基础设施不足和资源挑战。这些医疗保健差距导致生活在偏远社区的人们的健康状况明显差于那些生活在南部和城市地区、能够及时获得医疗服务的人。远程医疗在弥合获取医疗服务方面的长期差距方面发挥了关键作用，它将患者和提供者联系起来，跨越了距离。虽然萨斯喀彻温省北部的远程医疗的采用率在不断增长，但它的初步实施面临着一些障碍，这些障碍与有限和紧张的人力和财力资源、基础设施挑战（如不可靠的宽带）以及缺乏社区参与和参与式决策有关。在社区背景下远程医疗初步实施期间出现的一些新兴伦理问题涉及隐私问题，这些问题也影响了患者的体验，特别是需要考虑农村背景下的地点和空间。本文从萨斯喀彻温省四个北部社区的定性研究中汲取了资源挑战和基于地点的考虑因素的批判性观点，这些因素正在塑造萨斯喀彻温省的远程医疗，并提供了一些建议和经验教训，这些建议和经验教训可以为其他加拿大地区和国家提供参考。这项工作回应了加拿大农村社区远程医疗的伦理问题，并贡献了基于社区的服务提供商、顾问和研究人员的观点。
