Case management: considerations for working with diverse rural client systems

In recent years citations on case management have proliferated; however, only a few address this model relative to rural settings. There is wide variability in the definition of rural, but one constant remains; it can be demanding and costly to provide services in more remote regions. Accessibility issues are associated with low population density, transportation, and communication infrastructures coupled with great distances between healthcare services and providers. Such factors pose challenges for urban-based providers of health-related services to meet the needs of rural residents in their catchment areas. This article highlights demographic, geographic, economic, and socio-cultural considerations that could assist case managers to better meet the needs of their rural-based clients. The information herein is a synthesis of the literature, anecdotal reports by case managers who work with rural client-systems (a client and whomever he/she includes in their immediate support system), and the author's personal and professional experience in rural communities.