Background/Objectives: There exist several interconnected issues that hinder the development of family medicine in Commonwealth realms such as the United Kingdom, Canada, New Zealand, and Australia. These issues affect both the medical and nursing professions. Family physicians, in most countries including the United Kingdom, are not considered “specialists” and are called “general practitioners” instead. The term GP is an outdated and potentially demeaning term relegated to the early 20th century when they did not receive any more than a few rotations as staff grades before being allowed to run their own community clinic. Registered nurses often cover a minor and subaltern role when working as practice nurses in the UK. They are often replaced by cost-effective, licensed practical nurses in most other English-speaking countries. Nurse practitioners in the UK, though being de facto entirely equal to family physicians in countries like Canada, Australia, New Zealand, and most US states, do not hold a special registration status. Their training is not defined in specific legislation, and they do not function as alternatives to general practitioners in the sense that patient may register with them alone which is often the case in Canada or the USA. Family medicine is, therefore, generally left lacking leadership with members of the medical and nursing professions often struggling for “power” in a way that undermines the foundation of family medicine which is to serve the health needs of a large population ranging from children to seniors. Methods: The purpose of this paper is to describe a solution to management in a Family Medicine Clinic in Calgary, Alberta, Canada. Results: In this model, the physician-nurse team developed a highly trained role of Clinical Nurse Specialist which serves as an overall clinic manager. Conclusions: The implementation of the Clinical Nurse Specialist-led model in family medicine has improved clinic efficiency, patient access, and provider satisfaction. This approach demonstrates a viable framework for enhancing primary care management across Commonwealth realms.

Background/Objectives: Western Canadian and U.S. communities outside urban centres remain underserved by primary, specialist, emergency, mental health, and chronic-disease services. These access problems reflect distance, weather, workforce shortages, specialist maldistribution, primary care attachment gaps, broadband limitations, and the governance realities of Indigenous and Tribal communities. This scoping review with narrative synthesis examined how telehealth and virtual-care models affect rural access in western Canada and the western/frontier United States. Methods: Searches were completed on 21 May 2026 in PubMed/MEDLINE, Embase, CINAHL, Scopus, the Cochrane Library, and PubMed Central. Supplementary searches included Google Scholar, publisher platforms, reference-list checking, and official Canadian and U.S. health-system sources. Peer-reviewed evidence published from 1 January 2016 to 21 May 2026 was eligible when it addressed rural, remote, frontier, Indigenous, underserved, western, or northern healthcare settings and reported access, implementation, safety, continuity, equity, or service-use outcomes. Results: The search identified 112 records; 27 duplicates were removed, 85 records were screened, 37 full texts were assessed, and 28 peer-reviewed records were included. Seven official sources were retained separately. Evidence was mainly observational, qualitative, mixed-methods, implementation-focused, or review-level. Moderate confidence supported telehealth for travel reduction and specialist input, especially through eConsultation, provider-to-provider consultation, telementoring, and real-time emergency support. Confidence was low to moderate for hybrid primary care and telemental health, and low for durable reductions in emergency department use. Conclusions: Telehealth may be most appropriately implemented as a hybrid, locally anchored, culturally safe access model, not as a stand-alone substitute for rural primary care, specialist capacity, or emergency services. Implementation should include broadband support, local physical assessment capacity, documentation, continuity, patient education, and clear escalation pathways.

Background/Objectives: HbA1c is widely used to identify adults at increased risk of type 2 diabetes mellitus (T2DM), but major guidance differs on whether the lower limit of an HbA1c-defined risk range should be 5.7% (39 mmol/mol) or 6.0% (42 mmol/mol). This systematic review evaluated the prognostic and screening utility of HbA1c 5.7–6.4% compared with HbA1c 6.0–6.4% and examined whether available evidence supports threshold-based allocation of preventive interventions. Methods: The review was reported in accordance with PRISMA 2020 and registered in PROSPERO (CRD42019134344). PubMed/MEDLINE, Embase and the Cochrane Library were searched for studies published from 1 January 2016 to 1 January 2026. Eligible evidence comprised human studies in English, French, Hebrew, Italian or Spanish that evaluated HbA1c ranges below the diabetes diagnostic threshold in adults aged at least 40 years or younger adults with established risk factors. Two reviewers independently screened records and extracted data. Risk of bias was assessed using an adapted QUADAS-2 framework for threshold-performance evidence, supplemented by CASP-informed appraisal, and certainty was rated with GRADE domains. Narrative synthesis was selected because populations, thresholds, comparator tests, follow-up and outcome ascertainment were heterogeneous. Results: Seven studies were included. Evidence consistently supported a graded risk continuum rather than a single biological cut point. HbA1c 5.7–6.4% identifies more adults but includes many at low short-term absolute risk, whereas HbA1c 6.0–6.4%, especially 6.2–6.4% or combined HbA1c and fasting glucose abnormality, identifies fewer adults at higher near-term risk. Direct evidence comparing 5.7% versus 6.0% thresholds came mainly from one UK cohort, with supportive but indirect evidence from meta-analysis, routine-care cohorts and reversion studies. No trial randomized adults to intervention by HbA1c threshold, and eligible evidence did not directly address early diabetes-related morbidity by threshold. Conclusions: HbA1c below the diabetes diagnostic threshold should be interpreted as risk strata, not as a binary disease label. HbA1c 5.7–6.4% is defensible for broad, low-intensity preventive advice, while HbA1c 6.0–6.4% can be used to prioritize structured prevention and closer follow-up. The proposed tiered approach is a pragmatic, hypothesis-generating interpretation of the available evidence rather than a trial-validated intervention algorithm.

Background/Objectives: Registered nurse (RN) prescribing is framed as a strategy to expand primary care access, but the safest, most useful, or most appropriate model may not be autonomous RN prescribing alone. Systematic review of the evidence on how best to understand RN prescribing with respect to collaborative models and supports, outcomes and effect modifiers, and implementation strategy, contingency factors, or conditions. Methods: Searches completed March 30, 2026, included PubMed/MEDLINE-indexed records; PubMed Central full-text records; Cochrane Library search interface; publisher platforms; reference chasing; and Canadian, Alberta government, and professional organization sources for Canadian regulatory, policy, and practice information. Peer-reviewed, eligible evidence comprised systematic reviews, randomized trials, cohort and cross-sectional studies, qualitative studies, mixed-methods studies, and implementation studies related to nurse prescribing, RN-led primary care, nurse-physician/NP collaboration, non-medical prescribing, medication titration, or primary-care team models. CASP-informed appraisal, AMSTAR 2 principles, and GRADE domains were used to rate the methodological quality and certainty. Results: A total of 286 records were identified; following de-duplication, title/abstract and full-text screening, 33 peer-reviewed records were included in the narrative synthesis; and four official contextual sources informed regulatory interpretation. Literature shows nurse, non-medical prescribing can achieve comparable or improved patient outcomes for blood pressure, glycated hemoglobin, low-density lipoprotein cholesterol, medication adherence, satisfaction, and selected access outcomes. Conclusions: The strongest and most transferable model is coordinated RN prescribing, meaning embedded within a primary-care team in which family physicians and nurse practitioners remain available for diagnostic uncertainty, complex multimorbidity, high-risk prescribing, continuity, and escalation. Direct comparative evidence for this exact configuration is still limited, so future evaluations should test coordinated RN prescriber-FP/NP models using prospective implementation designs and patient-level outcomes.

Background/Objectives: Western Canadian and US communities beyond urban centres are routinely underserved by primary, specialist, and emergency care services, whether based in rural, remote, frontier or Indigenous settings. Access issues in these contexts have traditionally been framed by distance, weather, and clinician availability challenges, but also extend to specialist maldistribution, attachment gaps and uneven broadband availability. This systematic review and narrative evidence synthesis scoped the impact of telehealth and other virtual-care models on rural access to services, broadly construed to include timely access, travel burden, specialist input, emergency support, continuity and clinician support, safety, and equity, or impacts on service fairness and effectiveness. Methods: Searches conducted in May 2026 included PubMed/MEDLINE-indexed records, PubMed Central full-text records, the Cochrane Library search interface, publisher platforms, reference chasing, and official sources from Canadian and US health systems. Eligible evidence from 1 January 2016 through 6 May 2026 addressed rural, remote, frontier, Indigenous, underserved, western or northern health-service settings, with earlier landmark sources retained for historical framing where relevant. Results: The search identified 112 records; after de-duplication and screening, 28 eligible peer-reviewed records were included in the evidence synthesis and 7 official sources informed jurisdictional contextualization. Evidence supported virtual care as an access extender in contexts where it can reduce travel, enable specialist input or support rural clinicians, maintain continuity of chronic disease or mental health follow-up. Virtual care is best when paired with on-site physical assessment and in-person escalation pathways. Evidence was weaker for virtual-only models, and for durable effects on emergency department use. Conclusions: Telehealth should therefore be implemented as a hybrid, locally anchored, culturally safe access model rather than as a stand-alone substitute for rural primary care or specialist capacity.

Background/Objectives: Primary care access in Alberta, Canada is dictated by geography, attachment, timeliness, continuity, and local service burdening. Physician and primary care delivery in rural communities are subject to travel burden, workforce fragility, and intermittency, while suburban communities have immediate proximity to facilities, but are also challenged by delayed access, low attachment, and fragmented episodic care. These access challenges are echoed in rural and frontier contexts in the United States including the state of Wyoming. In this systematic review and narrative synthesis we investigated if and how care coordination between community pharmacists and family physicians, increases primary care access in rural and suburban Alberta, and how transferable those findings are to rural Wyoming and other similar frontier settings. Methods: We searched PubMed/MEDLINE, Embase, Scopus, CINAHL, and the Cochrane Library using controlled vocabulary and free-text terms to identify English-language peer-reviewed studies and practice-relevant evidence published from 1 January 2010 to 19 April 2026 related to primary care access, rural, suburban and frontier settings, Alberta, Wyoming, community pharmacy, pharmacist prescribing, physician-pharmacist collaboration, medication management, chronic disease care, continuity, and emergency department use. Earlier landmark primary-care, physician-pharmacist collaboration, and medication-safety studies were retained only when necessary for conceptual framing. Results: We screened 34 eligible records for inclusion in the narrative synthesis, and seven official contextual sources were included for jurisdictional interpretation. Strong evidence demonstrates that pharmacists are accessible primary care extenders where community services are coordinated with family physicians through documentation, referral pathways, red-flag protocols, and shared medication plans. The strongest evidence is specific to hypertension, cardiovascular risk reduction, and medication management and chronic disease monitoring. Direct Alberta-Wyoming comparative intervention evidence is limited. Conclusions: Physician-pharmacist coordinated care should be implemented prospectively as a geographically tailored access model, not a physician replacement model, with evaluation of access, continuity, medication safety, emergency department use and equity.